Provider Demographics
NPI:1740610351
Name:RIDLEY, BRIANNA NICOLE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:NICOLE
Last Name:RIDLEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:BRIANNA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2380 SOMERSET VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:TN
Mailing Address - Zip Code:37013-4488
Mailing Address - Country:US
Mailing Address - Phone:931-722-1817
Mailing Address - Fax:
Practice Address - Street 1:1214 GALLATIN AVE STE 101
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3270
Practice Address - Country:US
Practice Address - Phone:615-988-1620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-18
Last Update Date:2020-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN18123363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3380640OtherMEDICARE GROUP
TN3380640OtherMEDICAID GROUP
TNQ006289Medicaid