Provider Demographics
NPI:1508918954
Name:JARNES, RYAN (CRNA)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:JARNES
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 WIMBERLY WAY
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-7121
Mailing Address - Country:US
Mailing Address - Phone:407-401-3821
Mailing Address - Fax:407-401-3821
Practice Address - Street 1:400 HEALTH PARK BLVD
Practice Address - Street 2:
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:904-819-4993
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9227816367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG3849OtherBLUE CROSS
FL307265700Medicaid
FLG3849OtherBLUE CROSS