Provider Demographics
NPI:1225082621
Name:REDDY, TRICIA LYNNE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:LYNNE
Last Name:REDDY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8395 MULLIGAN CIR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3304
Mailing Address - Country:US
Mailing Address - Phone:772-408-4858
Mailing Address - Fax:
Practice Address - Street 1:951 BROKEN SOUND PKWY
Practice Address - Street 2:SUITE 115
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-3507
Practice Address - Country:US
Practice Address - Phone:561-241-6676
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9232938363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLQ65084Medicare UPIN