Healthcare Provider Details

I. General information

NPI: 1871063875
Provider Name (Legal Business Name): RYAN KILBANE MSN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/03/2018
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14527 7TH ST
DADE CITY FL
33523-3102
US

IV. Provider business mailing address

2995 DREW ST
CLEARWATER FL
33759-3012
US

V. Phone/Fax

Practice location:
  • Phone: 866-762-1743
  • Fax: 727-816-1222
Mailing address:
  • Phone: 727-315-7496
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11000557
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number9500352
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: