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General NPI Number Information
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NPI Number | 1598901613
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Entity Type | Organization
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Legal Business Name | S P RYAN INC
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Dates
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Enumeration Date | 12/18/2008
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Last Update Date | 12/18/2008
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Provider Practice Location Address
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Address Line | 3269 E ANGLERS STRM
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City | AVON PARK
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State | FL
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Zip | 33825-6020
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Country | US
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Telephone | 863-386-5044
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Fax | 863-386-5044
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Provider Business Mailing Address
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Address Line | 3269 E ANGLERS STRM
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City | AVON PARK
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State | FL
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Zip | 33825-6020
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Country | US
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Telephone | 863-386-5044
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Fax | 863-386-5044
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. SHARON RYAN
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Credential | CRNA
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Telephone | 863-386-5044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 9260092
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License Number State | FL
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