Healthcare Provider Details

I. General information

NPI: 1811849763
Provider Name (Legal Business Name): TRYAN FUNCTIONAL HEALTH SOLUTIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 BELLADONNA PL
SAINT CLOUD FL
34771-5813
US

IV. Provider business mailing address

1419 BELLADONNA PL
SAINT CLOUD FL
34771-5813
US

V. Phone/Fax

Practice location:
  • Phone: 407-246-1970
  • Fax: 407-734-1496
Mailing address:
  • Phone: 407-246-1970
  • Fax: 407-734-1496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TERESITA RYAN
Title or Position: MANAGER
Credential: APRN
Phone: 407-246-1970