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NPI Code Detail

MEDICARE: RYAN ABRAHAM CRNA

MEDICARE: RYAN ABRAHAM CRNA
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
1367500000XCertified Registered Nurse Anesthetist336781AZ
2367500000XCertified Registered Nurse Anesthetist901636MS
3163WC0200XCritical Care Medicine Registered NurseRN9309082FL

General Provider Information

NPI Number : 1639794324
Entity Type Code : Individual
Provider Name (Legal Business Name) : RYAN ABRAHAM CRNA
Provider Business Mailing Address
First Line : 17989 RESTORATION CIR
Second Line :
City : GULFPORT
State : MS
Zip : 39503-5237
Country : US
Telephone Number : 321-749-9317
Fax Number :
Provider Business Practice Location Address
First Line : 6200 N LA CHOLLA BLVD
Second Line :
City : TUCSON
State : AZ
Zip : 85741-3529
Country : US
Telephone Number : 520-742-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2020
Last Update Date : 03/17/2026

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