Healthcare Provider Details

I. General information

NPI: 1386553154
Provider Name (Legal Business Name): RYAN FOLLIARD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6120 STATE ROAD 70 E
BRADENTON FL
34203-9712
US

IV. Provider business mailing address

6120 STATE ROAD 70 E
BRADENTON FL
34203-9712
US

V. Phone/Fax

Practice location:
  • Phone: 630-460-0250
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11049751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: