Provider Demographics
NPI:1558040576
Name:EFAW, RYAN
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:
Last Name:EFAW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8237 LANETTE ST
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32220-2552
Mailing Address - Country:US
Mailing Address - Phone:904-515-7994
Mailing Address - Fax:
Practice Address - Street 1:8237 LANETTE ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32220-2552
Practice Address - Country:US
Practice Address - Phone:904-515-7994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-17
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
374J00000X
FLCRPS.0100298.A175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No374J00000XNursing Service Related ProvidersDoula