Individual
JENNIFER RIDENOURE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.C
Contact information
Practice address
1330 RIVERLAND RD, FORT LAUDERDALE, FL 33312-2961
(954) 321-9826
(954) 321-9660
Mailing address
2936 CAMBRIDGE LN, HOLLYWOOD, FL 33026-3748
(954) 704-0108
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103460
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292299100
—
FL
Enumeration date
08/20/2006
Last updated
07/08/2007
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