Provider Demographics
NPI:1972826725
Name:RIDDLE, COLLEEN M (RN)
Entity Type:Individual
Prefix:MS
First Name:COLLEEN
Middle Name:M
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4220 SHADOW WOOD RUN
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-1526
Mailing Address - Country:US
Mailing Address - Phone:863-808-7861
Mailing Address - Fax:
Practice Address - Street 1:4220 SHADOW WOOD RUN
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-1526
Practice Address - Country:US
Practice Address - Phone:863-808-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-09
Last Update Date:2010-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN1652182163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse