Provider Demographics
NPI:1548503774
Name:RICHARDSON, TINA M (CMA)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22516 HIGHWAY 36 APT D215
Mailing Address - Street 2:
Mailing Address - City:ABITA SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70420-3840
Mailing Address - Country:US
Mailing Address - Phone:985-400-5190
Mailing Address - Fax:
Practice Address - Street 1:22516 HIGHWAY 36 APT D215
Practice Address - Street 2:
Practice Address - City:ABITA SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70420-3840
Practice Address - Country:US
Practice Address - Phone:985-400-5190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-06
Last Update Date:2013-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1522-16703747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant