Provider Demographics
NPI:1124589502
Name:RIDLEY, JOHNNA RENEE (FNP-BC)
Entity Type:Individual
Prefix:DR
First Name:JOHNNA
Middle Name:RENEE
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9970 CENTRAL PARK BLVD N STE 403
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-2236
Mailing Address - Country:US
Mailing Address - Phone:561-910-7300
Mailing Address - Fax:
Practice Address - Street 1:9970 CENTRAL PARK BLVD N STE 403
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-2236
Practice Address - Country:US
Practice Address - Phone:561-910-7300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-27
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11024469363LF0000X
MO2023004930363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily