Provider Demographics
NPI:1457015711
Name:1 STOP MEDICAL SHOP LLC
Entity Type:Organization
Organization Name:1 STOP MEDICAL SHOP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RYDER
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:727-816-9736
Mailing Address - Street 1:5036 TROUBLE CREEK RD
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34652-4904
Mailing Address - Country:US
Mailing Address - Phone:727-816-9736
Mailing Address - Fax:217-216-5092
Practice Address - Street 1:5036 TROUBLE CREEK RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-4904
Practice Address - Country:US
Practice Address - Phone:727-816-9736
Practice Address - Fax:217-216-5092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-23
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty