Provider Demographics
NPI:1144899535
Name:MOTHERSIL, RICHARDSON
Entity type:Individual
Prefix:
First Name:RICHARDSON
Middle Name:
Last Name:MOTHERSIL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16940 SW 5TH CT
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1527
Mailing Address - Country:US
Mailing Address - Phone:786-991-8905
Mailing Address - Fax:
Practice Address - Street 1:175 S STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:MARGATE
Practice Address - State:FL
Practice Address - Zip Code:33068-5722
Practice Address - Country:US
Practice Address - Phone:954-586-4343
Practice Address - Fax:954-827-7800
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11008345363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner