Healthcare Provider Details

I. General information

NPI: 1386348761
Provider Name (Legal Business Name): RYAN LANTZ RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2023
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 COBBLE CRK
PENSACOLA FL
32504-8638
US

IV. Provider business mailing address

3045 PATRICIA DR
PENSACOLA FL
32526-3573
US

V. Phone/Fax

Practice location:
  • Phone: 850-473-4800
  • Fax:
Mailing address:
  • Phone: 850-281-8758
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN9602949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: