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General NPI Number Information
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NPI Number | 1295588663
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Entity Type | Individual
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Provider Name | FELICIA RICHARDSON
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Gender | Female
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/09/2024
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Provider Practice Location Address
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Address Line | 35 SE 1ST AVE STE 200D-7
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City | OCALA
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State | FL
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Zip | 34471-2176
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Country | US
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Telephone | 407-968-0121
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Fax |
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Provider Business Mailing Address
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Address Line | 6336 BAYLOR AVE
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City | KEYSTONE HEIGHTS
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State | FL
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Zip | 32656-6032
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Country | US
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Telephone | 407-968-0121
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 372600000X
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Taxonomy Name | Adult Companion
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License Number | 112942900
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License Number State | FL
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