Healthcare Provider Details

I. General information

NPI: 1063182194
Provider Name (Legal Business Name): RYAN KELSEY GAVAGNI FIORENTINO ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2021
Last Update Date: 11/02/2026
Certification Date: 11/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 NW 13TH ST
BOCA RATON FL
33486-2269
US

IV. Provider business mailing address

3960 DORRIT AVE
BOYNTON BEACH FL
33436-2734
US

V. Phone/Fax

Practice location:
  • Phone: 561-300-0600
  • Fax:
Mailing address:
  • Phone: 561-601-4976
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberARNP11016760
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: