Provider Demographics
NPI:1205487568
Name:RIDDLE, ROBIN LEE ANN (NP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE ANN
Last Name:RIDDLE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7201 ENGLE RD
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-2228
Mailing Address - Country:US
Mailing Address - Phone:260-432-1800
Mailing Address - Fax:260-479-3520
Practice Address - Street 1:7201 ENGLE RD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-2228
Practice Address - Country:US
Practice Address - Phone:260-432-1800
Practice Address - Fax:260-434-1801
Is Sole Proprietor?:No
Enumeration Date:2019-09-26
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71009606A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300033536Medicaid