Healthcare Provider Details

I. General information

NPI: 1447462213
Provider Name (Legal Business Name): NANCY RIDER R.D.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 BRUCE B DOWNS BLVD
TAMPA FL
33612-4745
US

IV. Provider business mailing address

2953 BANYAN HILL LN
LAND O LAKES FL
34639-6786
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-7511
  • Fax:
Mailing address:
  • Phone: 813-972-7511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberDH 17365
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: