Individual
TICE RIDLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19717 BOWER RD, DADE CITY, FL 33523-6867
(773) 859-9006
(727) 499-7526
Mailing address
PO BOX 406, BAY PINES, FL 33744-0406
(866) 410-3774
(727) 499-7526
Taxonomy
Speciality
Code
Description
License number
State
311ZA0620X
Adult Care Home Facility
Primary
—
—
Other
Enumeration date
06/03/2020
Last updated
06/03/2020
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