Individual
TARA MICHELLE RIDGEWAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
APRN
Contact information
Practice address
530 E HUNT HWY STE 103-140, SAN TAN VALLEY, AZ 85143-5224
(480) 605-4670
Mailing address
530 E HUNT HWY STE 103-140, SAN TAN VALLEY, AZ 85143-5224
(480) 605-4670
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
209019368
IL
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
231483
AZ
Other
Enumeration date
10/22/2019
Last updated
01/06/2021
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