Provider Demographics
NPI:1609447440
Name:DOUTHETT, RYLAN JACOB (DNP, APRN, FNP-BC)
Entity Type:Individual
Prefix:MR
First Name:RYLAN
Middle Name:JACOB
Last Name:DOUTHETT
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 NW 51ST ST APT E93
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-8307
Mailing Address - Country:US
Mailing Address - Phone:941-704-6879
Mailing Address - Fax:
Practice Address - Street 1:4000 NW 51ST ST APT E93
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-8307
Practice Address - Country:US
Practice Address - Phone:941-704-6879
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11013493363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily