MEDICARE: MR. RYAN WILSON MACALUA ARNP, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP9204952	FL
2	363LF0000X	Family Nurse Practitioner	ARNP9204952	FL
3	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN9204952	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174919377
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RYAN WILSON MACALUA ARNP, FNP-C

Provider Business Mailing Address
First Line	:	9009 CORPORATE LAKE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2367
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9009 CORPORATE LAKE DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-2367
Country	:	US
Telephone Number	:	407-274-8267
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2015
Last Update Date	:	12/05/2025

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