Provider Demographics
NPI:1447802541
Name:RYAN, ALEXIS (CLC)
Entity Type:Individual
Prefix:MRS
First Name:ALEXIS
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:CLC
Other - Prefix:MISS
Other - First Name:ALEXIS
Other - Middle Name:CIERA
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:820 BURLAND CIR
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-2189
Mailing Address - Country:US
Mailing Address - Phone:407-473-0786
Mailing Address - Fax:
Practice Address - Street 1:820 BURLAND CIR
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-2189
Practice Address - Country:US
Practice Address - Phone:407-473-0786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLALPP-318336174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN