Provider Demographics
NPI:1689077372
Name:RIDGWAY, JENNIFER L (APRN, PNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:L
Last Name:RIDGWAY
Suffix:
Gender:F
Credentials:APRN, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1131 MADISON MILL DR
Mailing Address - Street 2:
Mailing Address - City:NOLENSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37135-3031
Mailing Address - Country:US
Mailing Address - Phone:770-295-9681
Mailing Address - Fax:
Practice Address - Street 1:4700 WATERS AVE
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31404-6220
Practice Address - Country:US
Practice Address - Phone:912-350-8180
Practice Address - Fax:912-350-5697
Is Sole Proprietor?:No
Enumeration Date:2014-10-08
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN222180363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAPENDINGMedicaid
SCPENDINGMedicaid
GAPENDINGMedicare PIN