MEDICARE: DR. STEPHANIE RIDGEWAY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS58436	FL

General Provider Information

NPI Number	:	1295347557
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE RIDGEWAY

Provider Business Mailing Address
First Line	:	2405 MAYPORT RD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-6390
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2405 MAYPORT RD
Second Line	:
City	:	ATLANTIC BEACH
State	:	FL
Zip	:	32233-6390
Country	:	US
Telephone Number	:	904-435-0509
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2020
Last Update Date	:	08/18/2020

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Directions to “ DR. STEPHANIE RIDGEWAY ” Practice Location

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