Provider Demographics
NPI:1205560810
Name:RYDMAN, ANN PARKER
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:PARKER
Last Name:RYDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ANN
Other - Middle Name:RENE
Other - Last Name:PARKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:203 SAFARI LOOP
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-8798
Mailing Address - Country:US
Mailing Address - Phone:850-382-4658
Mailing Address - Fax:
Practice Address - Street 1:203 SAFARI LOOP
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-8798
Practice Address - Country:US
Practice Address - Phone:850-382-4658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-11
Last Update Date:2022-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM69172363L00000X
FL9436440163WC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine