Provider Demographics
NPI:1700890175
Name:RITTER WIGGS, PAMELA MICHELE (ARNP)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:MICHELE
Last Name:RITTER WIGGS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MICHELE
Other - Last Name:RITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:1600 SW ARCHER RD # D1-121
Mailing Address - Street 2:STE C
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0383
Mailing Address - Country:US
Mailing Address - Phone:352-265-8989
Mailing Address - Fax:352-265-8989
Practice Address - Street 1:1600 ARCHER RD D1-121
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:31610
Practice Address - Country:US
Practice Address - Phone:352-265-8989
Practice Address - Fax:352-265-8968
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2018-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1427272363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020200100Medicaid
FLY1077XMedicare PIN
P61462Medicare UPIN
FL020200100Medicaid