Individual
NICOLE CARNEVALLA RIDDELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5707 N 22ND ST, TAMPA, FL 33610-4350
(813) 239-8069
(813) 272-3766
Mailing address
5707 N 22ND ST, TAMPA, FL 33610-4350
(813) 239-8069
(813) 272-3766
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME72658
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
41654X
MEDICARE PTAN
FL
Enumeration date
10/04/2006
Last updated
05/04/2022
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