Provider Demographics
NPI:1902384712
Name:RYDLEWSKI, JENNA MARIE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:JENNA
Middle Name:MARIE
Last Name:RYDLEWSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JENNA
Other - Middle Name:MARIE
Other - Last Name:GILBOY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2814 W. VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607
Mailing Address - Country:US
Mailing Address - Phone:813-262-1380
Mailing Address - Fax:813-262-1335
Practice Address - Street 1:2814 W. VIRGINIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607
Practice Address - Country:US
Practice Address - Phone:813-262-1380
Practice Address - Fax:813-262-1335
Is Sole Proprietor?:No
Enumeration Date:2018-08-02
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9368233363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100683900Medicaid