Provider Demographics
NPI:1861667677
Name:RIDGE, JANE ALLISON (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ALLISON
Last Name:RIDGE
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:JANE
Other - Middle Name:ALLISON
Other - Last Name:HOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNA
Mailing Address - Street 1:1451 HARBOR ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:PORT ISABEL
Mailing Address - State:TX
Mailing Address - Zip Code:78578-2526
Mailing Address - Country:US
Mailing Address - Phone:956-943-1752
Mailing Address - Fax:956-943-1752
Practice Address - Street 1:1451 HARBOR ISLAND DR
Practice Address - Street 2:
Practice Address - City:PORT ISABEL
Practice Address - State:TX
Practice Address - Zip Code:78578-2526
Practice Address - Country:US
Practice Address - Phone:956-943-1752
Practice Address - Fax:956-943-1752
Is Sole Proprietor?:No
Enumeration Date:2008-04-23
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX21518207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3372OtherCALIFORNIA CRNA LICENSE
CA678888OtherCALIFORNIA RN LICENSE
TX00C39BOtherMEDICARE/BLUE CROSS
TX21518OtherNATIONAL AANA CERTIFICATION
TX427137OtherTEXAS LICENSE