Provider Demographics
NPI:1710374855
Name:RIDGEWAY, NACCOLAINE (WHNP-BC)
Entity type:Individual
Prefix:
First Name:NACCOLAINE
Middle Name:
Last Name:RIDGEWAY
Suffix:
Gender:F
Credentials:WHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 FOSTER AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37210-5307
Mailing Address - Country:US
Mailing Address - Phone:615-227-3000
Mailing Address - Fax:
Practice Address - Street 1:617 S 8TH ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37206-3819
Practice Address - Country:US
Practice Address - Phone:615-227-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-04-15
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127858363LW0102X
TN37321363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3707424-03Medicaid
TX370742401Medicaid