Healthcare Provider Details

I. General information

NPI: 1225947971
Provider Name (Legal Business Name): SHARDRICK TERRENCE RIDLEY MSN, APRN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TONY RIDLEY MSN, APRN, FNP-C

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 NW 16TH ST
MIAMI FL
33125-1624
US

IV. Provider business mailing address

8496 NW 52ND PL
CORAL SPRINGS FL
33067-2841
US

V. Phone/Fax

Practice location:
  • Phone: 305-575-7000
  • Fax:
Mailing address:
  • Phone: 845-825-4303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11034924
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: