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General NPI Number Information
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NPI Number | 1457015711
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Entity Type | Organization
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Legal Business Name | 1 STOP MEDICAL SHOP LLC
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Dates
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Enumeration Date | 10/23/2021
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Last Update Date | 10/23/2021
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Provider Practice Location Address
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Address Line | 5036 TROUBLE CREEK RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4904
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Country | US
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Telephone | 727-816-9736
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Fax | 217-216-5092
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Provider Business Mailing Address
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Address Line | 5036 TROUBLE CREEK RD
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City | NEW PORT RICHEY
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State | FL
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Zip | 34652-4904
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Country | US
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Telephone | 727-816-9736
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Fax | 217-216-5092
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Authorized Official
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Title or Position | OWNER
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Name | MS. DEBORA LYNN RYDER
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Credential | APRN
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Telephone | 727-816-9736
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number |
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License Number State |
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