Healthcare Provider Details

I. General information

NPI: 1043451792
Provider Name (Legal Business Name): YVETTE MCCREA-RYAN, MD, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2009
Last Update Date: 03/10/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13057 SUMMERFIELD SQUARE DR
RIVERVIEW FL
33578-7402
US

IV. Provider business mailing address

PO BOX 3702
SEBRING FL
33871-3702
US

V. Phone/Fax

Practice location:
  • Phone: 863-471-1413
  • Fax: 863-471-1416
Mailing address:
  • Phone: 863-471-1413
  • Fax: 863-471-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0073833
License Number StateFL

VIII. Authorized Official

Name: MS. YVETTE M MCCREA-RYAN
Title or Position: OWNER
Credential: MD
Phone: 863-471-1413