Provider Demographics
NPI:1073525655
Name:BEADLE, RYAN (PA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:BEADLE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21550 ANGELA LN
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34293-2017
Mailing Address - Country:US
Mailing Address - Phone:941-493-7400
Mailing Address - Fax:941-493-1940
Practice Address - Street 1:21550 ANGELA LN
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34293-2017
Practice Address - Country:US
Practice Address - Phone:941-493-7400
Practice Address - Fax:941-493-1940
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant