Provider Demographics
NPI:1013660794
Name:RIDDLE, TRICIA A (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:TRICIA
Middle Name:A
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:TRICIA
Other - Middle Name:ANN
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:514 SE PORT ST LUCIE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34984-5108
Mailing Address - Country:US
Mailing Address - Phone:772-871-5900
Mailing Address - Fax:
Practice Address - Street 1:514 SE PORT ST LUCIE BLVD
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34984-5108
Practice Address - Country:US
Practice Address - Phone:772-871-5900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-01
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11017304363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner