Healthcare Provider Details

I. General information

NPI: 1093889289
Provider Name (Legal Business Name): RYAN CHRISTOPHER RICHARDSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 59TH ST W STE B
BRADENTON FL
34209-7006
US

IV. Provider business mailing address

2225 59TH ST W STE B
BRADENTON FL
34209-7006
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-1412
  • Fax: 941-795-0753
Mailing address:
  • Phone: 941-792-1412
  • Fax: 941-795-0753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9113056
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: