Healthcare Provider Details

I. General information

NPI: 1659107027
Provider Name (Legal Business Name): RYAN HOLLIS PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2024
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 VETERANS PARK DR STE 201
NAPLES FL
34109-0446
US

IV. Provider business mailing address

16150 ALLURA DR UNIT 5313
NAPLES FL
34110-9330
US

V. Phone/Fax

Practice location:
  • Phone: 239-260-1033
  • Fax:
Mailing address:
  • Phone: 727-470-8009
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: