Nicole Carnevalla Riddell, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

ME72658 Issued in FL

Practice address

5707 N 22ND St
Tampa, FL 33610-4350

Phone

(813) 239-8069

Fax

(813) 272-3766

NPI assigned

Oct 4, 2006

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Psychiatry

Education

University of South Florida College of Medicine, 1993

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Ibis Healthcare IncGroup PAC ID 2769469204, 24 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ibis Healthcare Inc

  • Community/Behavioral Health Agency
  • Tampa, FL
  • NPI 1346224011
  Medicare reassignment Care Compare group NPD
• Ibis Healthcare Inc

  • Federally Qualified Health Center (FQHC)
  • Tampa, FL
  • NPI 1922777218
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1159920000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651622400000",
    "number": "1750476537",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5707 N 22ND ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336104350",
            "telephone_number": "813-239-8069",
            "fax_number": "813-272-3766"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5707 N 22ND ST",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336104350",
            "telephone_number": "813-239-8069",
            "fax_number": "813-272-3766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RIDDELL",
        "first_name": "NICOLE",
        "middle_name": "CARNEVALLA",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-10-04",
        "last_updated": "2022-05-04",
        "certification_date": "2022-05-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "FL",
            "license": "ME72658",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "41654X",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Bridget Rickman, AU.D.
• Clayton L. Ricks, DMD
• Ricky P. Lockett, D.O, PA
• Rico Lab Services
• Juan Felipe Rico, MD
• Scott R. Riddell, MD
• Emma Rouse Riddle, PA-C
• Teresa M Riddle
• Ride Well Transportation L.L.C
• Ride2Care Transportation LLC

• Psychiatry Physician in Tampa, FL
• Providers in Tampa, FL by specialty
• Psychiatry Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.