MEDICARE: DRYP FLORIDA LLC

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
2	208600000X	Surgery Physician

General Provider Information

NPI Number	:	1376364349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DRYP FLORIDA LLC

Provider Business Mailing Address
First Line	:	212 SILVERADO DR
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34119-4614
Country	:	US
Telephone Number	:	740-637-8038
Fax Number	:

Provider Business Practice Location Address
First Line	:	3411 TAMIAMI TRL N STE 204
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34103-3700
Country	:	US
Telephone Number	:	239-300-8171
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	SHELLY MILLER
Credential	:	RN
Telephone Number	:	740-637-8038

Provider Enumeration Date	:	10/22/2024
Last Update Date	:	11/20/2024

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Directions to “DRYP FLORIDA LLC ” Practice Location

Language	Start Address	Practice Location

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