Provider Demographics
NPI:1700890175
Name:WIGGS, PAMELA RITTER (ARNP)
Entity type:Individual
Prefix:MRS
First Name:PAMELA
Middle Name:RITTER
Last Name:WIGGS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:MICHELE
Other - Last Name:RITTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:345 W MADISON ST
Mailing Address - Street 2:
Mailing Address - City:STARKE
Mailing Address - State:FL
Mailing Address - Zip Code:32091-3923
Mailing Address - Country:US
Mailing Address - Phone:904-964-5455
Mailing Address - Fax:904-964-4099
Practice Address - Street 1:175 N LAWRENCE BLVD
Practice Address - Street 2:
Practice Address - City:KEYSTONE HEIGHTS
Practice Address - State:FL
Practice Address - Zip Code:32656-9351
Practice Address - Country:US
Practice Address - Phone:352-473-3199
Practice Address - Fax:352-473-4199
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2025-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1427272363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020200100Medicaid
FLY1077XMedicare PIN
P61462Medicare UPIN
FL020200100Medicaid