Individual
AMANDA RIDDLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4634
Mailing address
1301 PENNSYLVANIA AVE, FORT WORTH, TX 76104-2122
(817) 250-4634
Taxonomy
Speciality
Code
Description
License number
State
363LA2100X
Acute Care Nurse Practitioner
Primary
1134077
TX
363LG0600X
Gerontology Nurse Practitioner
1134077
TX
Other
Enumeration date
09/20/2023
Last updated
09/20/2023
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