Healthcare Provider Details

I. General information

NPI: 1457195406
Provider Name (Legal Business Name): JOCELYN RIDEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2024
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 S ORANGE AVE STE 920N
ORLANDO FL
32801-3234
US

IV. Provider business mailing address

121 S ORANGE AVE STE 920N
ORLANDO FL
32801-3234
US

V. Phone/Fax

Practice location:
  • Phone: 407-610-1774
  • Fax: 407-610-1775
Mailing address:
  • Phone: 407-610-1774
  • Fax: 407-610-1775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11033587
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: