| Doctor Name: | TRACY LEE RIDDLE |
| NPI Number: | 1083890271 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ARNP-C |
| License Number: | ARNP9244294 |
| Business Practice Address: | 10762 Se Us Highway 441 Belleview, FL - 344203805 |
| Business Phone Number: | 3523475225 |
| Business Fax Number: | 3523471073 |
| Mailing Address: | 10762 Se Us Highway 441, BELLEVIEW |
| State: | FL |
| Postal Code: | 344203805 |
| Phone Number: | 3523475225 |
| Fax Number: | 3523471073 |
| NPI Enumeration Date: | 01/17/2008 |
| NPI Last Update Date: | 09/11/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | ARNP9244294 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |