MEDICARE: RYAN RISH

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	1041C0700X	Clinical Social Worker	SW25444	FL

General Provider Information

NPI Number	:	1417721457
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYAN RISH

Provider Business Mailing Address
First Line	:	3015 PARENTAL HOME RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-5768
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	836 PRUDENTIAL DR STE 1507
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8342
Country	:	US
Telephone Number	:	904-376-3800
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	02/16/2026

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Directions to “ RYAN RISH ” Practice Location

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