Healthcare Provider Details

I. General information

NPI: 1831650795
Provider Name (Legal Business Name): RYAN SCREVEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2019
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17 DAVIS BLVD STE 208
TAMPA FL
33606-3475
US

IV. Provider business mailing address

3509 COLD HARBOR LN
MOUNTAIN BRK AL
35223-1635
US

V. Phone/Fax

Practice location:
  • Phone: 813-974-2201
  • Fax:
Mailing address:
  • Phone: 205-317-9943
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number205469
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: