Provider Demographics
NPI:1205070679
Name:RITTER, JARED TRISTAN (MD)
Entity type:Individual
Prefix:DR
First Name:JARED
Middle Name:TRISTAN
Last Name:RITTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 PALM COAST PKWY SW UNIT 4
Mailing Address - Street 2:
Mailing Address - City:PALM COAST
Mailing Address - State:FL
Mailing Address - Zip Code:32137-4772
Mailing Address - Country:US
Mailing Address - Phone:386-569-4257
Mailing Address - Fax:888-533-4883
Practice Address - Street 1:389 PALM COAST PKWY SW UNIT 4
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32137-4772
Practice Address - Country:US
Practice Address - Phone:386-569-4257
Practice Address - Fax:888-533-4883
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-28
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI172122084P0800X
FLME1187432084P0800X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program