Healthcare Provider Details

I. General information

NPI: 1043912363
Provider Name (Legal Business Name): RYAN FITZPATRICK CST/CSFA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29253 US HIGHWAY 19 N
CLEARWATER FL
33761-2102
US

IV. Provider business mailing address

7324 SOUTHWEST FWY STE 1550
HOUSTON TX
77074-2053
US

V. Phone/Fax

Practice location:
  • Phone: 727-313-4764
  • Fax: 727-313-4764
Mailing address:
  • Phone: 713-779-9800
  • Fax: 713-779-9813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number205999
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: