MEDICARE: RHONDA RICHARDSON PMHNP-BC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	11015542	FL

General Provider Information

NPI Number	:	1801567540
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RHONDA RICHARDSON PMHNP-BC

Provider Business Mailing Address
First Line	:	9 OLD KINGS ROAD
Second Line	:	STE 123 #1012
City	:	PALM COAST
State	:	FL
Zip	:	32137-4706
Country	:	US
Telephone Number	:	386-230-4448
Fax Number	:	386-343-7206

Provider Business Practice Location Address
First Line	:	160 CYPRESS POINT PKWY STE B303
Second Line	:
City	:	PALM COAST
State	:	FL
Zip	:	32164-8443
Country	:	US
Telephone Number	:	386-230-4448
Fax Number	:	386-343-7206

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/22/2021
Last Update Date	:	09/22/2023

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