Healthcare Provider Details

I. General information

NPI: 1710294855
Provider Name (Legal Business Name): ABDELKADER RYAN NACHIT PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2010
Last Update Date: 01/07/2020
Certification Date: 01/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

IV. Provider business mailing address

3090 CARUSO CT STE 20
ORLANDO FL
32806-8510
US

V. Phone/Fax

Practice location:
  • Phone: 407-498-3620
  • Fax:
Mailing address:
  • Phone: 321-841-8191
  • Fax: 404-426-7443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA9105600
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: