=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699052340
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH BROOKE RYAN ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/09/2011
-----------------------------------------------------
Last Update Date | 08/30/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 901 NW 17TH ST STE 10A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1135
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-326-6590
-----------------------------------------------------
Fax | 305-326-6585
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 900 NW 17TH ST STE 10A
-----------------------------------------------------
City | MIAMI
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33136-1119
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-326-6590
-----------------------------------------------------
Fax | 305-326-6585
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2100X
-----------------------------------------------------
Taxonomy Name | Acute Care Nurse Practitioner
-----------------------------------------------------
License Number | 9256543
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------