Healthcare Provider Details

I. General information

NPI: 1972057735
Provider Name (Legal Business Name): RYAN G ZWAN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2016
Last Update Date: 06/22/2021
Certification Date: 06/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4361 S ALITA TER
HOMOSASSA FL
34446-1623
US

IV. Provider business mailing address

4361 S ALITA TER
HOMOSASSA FL
34446-1623
US

V. Phone/Fax

Practice location:
  • Phone: 813-995-5808
  • Fax:
Mailing address:
  • Phone: 813-995-5808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberCG60644590
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License NumberQ242678848
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: