Healthcare Provider Details

I. General information

NPI: 1205560810
Provider Name (Legal Business Name): ANN PARKER RYDMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANN RENE PARKER

II. Dates (important events)

Enumeration Date: 07/11/2022
Last Update Date: 08/05/2022
Certification Date: 08/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 SAFARI LOOP
CLOVIS NM
88101-8798
US

IV. Provider business mailing address

203 SAFARI LOOP
CLOVIS NM
88101-8798
US

V. Phone/Fax

Practice location:
  • Phone: 850-382-4658
  • Fax:
Mailing address:
  • Phone: 850-382-4658
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number69172
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number9436440
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: