Provider Demographics
NPI:1215392154
Name:RYAN, TERESITA (APRN)
Entity Type:Individual
Prefix:MRS
First Name:TERESITA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:MS
Other - First Name:TERESITA
Other - Middle Name:
Other - Last Name:HENAO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:1877 FORTUNE RD
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-4428
Mailing Address - Country:US
Mailing Address - Phone:407-943-8600
Mailing Address - Fax:407-932-5150
Practice Address - Street 1:1050 GRAPE AVE
Practice Address - Street 2:
Practice Address - City:SAINT CLOUD
Practice Address - State:FL
Practice Address - Zip Code:34769-3965
Practice Address - Country:US
Practice Address - Phone:407-943-8600
Practice Address - Fax:833-464-3650
Is Sole Proprietor?:No
Enumeration Date:2015-12-18
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9298416363LF0000X
FLARNP9298416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101231600Medicaid