Provider Demographics
NPI:1164704086
Name:RIDDLE, GINGER CROSBY (PA)
Entity Type:Individual
Prefix:
First Name:GINGER
Middle Name:CROSBY
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:GINGER
Other - Middle Name:CROSBY
Other - Last Name:MORGANTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:305 MEMORIAL MEDICAL PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5170
Mailing Address - Country:US
Mailing Address - Phone:386-672-1023
Mailing Address - Fax:386-263-2996
Practice Address - Street 1:4645 NW 8TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-4524
Practice Address - Country:US
Practice Address - Phone:352-375-1212
Practice Address - Fax:352-331-9095
Is Sole Proprietor?:No
Enumeration Date:2011-09-16
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9106149363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant