Healthcare Provider Details

I. General information

NPI: 1376364349
Provider Name (Legal Business Name): DRYP FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2024
Last Update Date: 11/20/2024
Certification Date: 11/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3411 TAMIAMI TRL N STE 204
NAPLES FL
34103-3700
US

IV. Provider business mailing address

212 SILVERADO DR
NAPLES FL
34119-4614
US

V. Phone/Fax

Practice location:
  • Phone: 239-300-8171
  • Fax:
Mailing address:
  • Phone: 740-637-8038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SHELLY MILLER
Title or Position: CEO
Credential: RN
Phone: 740-637-8038