Healthcare Provider Details

I. General information

NPI: 1295386142
Provider Name (Legal Business Name): RYAN HUFFORD LAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 11/06/2024
Certification Date: 11/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5930 SE 126TH ST
BELLEVIEW FL
34420-5204
US

IV. Provider business mailing address

8500 SE 160TH PL
SUMMERFIELD FL
34491-5551
US

V. Phone/Fax

Practice location:
  • Phone: 352-657-0519
  • Fax:
Mailing address:
  • Phone: 352-657-0519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAP4094
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: