Provider Demographics
NPI:1801516018
Name:RIDGE, KRISTEN MARIE (PA)
Entity type:Individual
Prefix:MRS
First Name:KRISTEN
Middle Name:MARIE
Last Name:RIDGE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MS
Other - First Name:KRISTEN
Other - Middle Name:MARIE
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:101 RIVERFRONT BLVD STE 710
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-8812
Mailing Address - Country:US
Mailing Address - Phone:941-776-4000
Mailing Address - Fax:
Practice Address - Street 1:170 N LIME AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6122
Practice Address - Country:US
Practice Address - Phone:941-867-0127
Practice Address - Fax:941-413-5904
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2024-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant