Provider Demographics
NPI:1205010394
Name:RUTLEDGE, RYAN ALAN (CRNA, MS)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:ALAN
Last Name:RUTLEDGE
Suffix:
Gender:M
Credentials:CRNA, MS
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3012
Mailing Address - Street 2:
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32085-3012
Mailing Address - Country:US
Mailing Address - Phone:866-480-2246
Mailing Address - Fax:770-237-1124
Practice Address - Street 1:400 HEALTH PARK BLVD
Practice Address - Street 2:LIGHTHOUSE ANESTHESIOLOGY CONSULTANTS
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5784
Practice Address - Country:US
Practice Address - Phone:904-819-4478
Practice Address - Fax:770-237-1124
Is Sole Proprietor?:No
Enumeration Date:2007-12-25
Last Update Date:2007-12-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3056702367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL3056702OtherTN NURSING LICENSE