Provider Demographics
NPI:1508757576
Name:RIDGELL, TIFFANY MONIQUE
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:MONIQUE
Last Name:RIDGELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 NORTH EL CAMINO REAL
Mailing Address - Street 2:312
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:504-812-5789
Mailing Address - Fax:
Practice Address - Street 1:124 ASHLEY 165 ROAD
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILL
Practice Address - State:AR
Practice Address - Zip Code:71642
Practice Address - Country:US
Practice Address - Phone:504-812-5789
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-09
Last Update Date:2025-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)