Healthcare Provider Details

I. General information

NPI: 1487818423
Provider Name (Legal Business Name): RYAN J EBDRUP CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2008
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

PO BOX 861348
ORLANDO FL
32886-1348
US

V. Phone/Fax

Practice location:
  • Phone: 913-647-2055
  • Fax:
Mailing address:
  • Phone: 913-647-2055
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP9198052
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: