Provider Demographics
NPI:1376656462
Name:RIPPLE, RON HENRY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RON
Middle Name:HENRY
Last Name:RIPPLE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 MORTON PLANT ST STE 301
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3395
Mailing Address - Country:US
Mailing Address - Phone:727-461-6026
Mailing Address - Fax:727-298-5205
Practice Address - Street 1:430 MORTON PLANT ST STE 301
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3395
Practice Address - Country:US
Practice Address - Phone:727-461-6026
Practice Address - Fax:727-461-1492
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103733363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
UTS17511Medicare UPIN
UT005549107Medicare ID - Type Unspecified