Provider Demographics
NPI:1639348188
Name:PATRICIA JO RYAN PHD PA
Entity Type:Organization
Organization Name:PATRICIA JO RYAN PHD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:941-486-1930
Mailing Address - Street 1:1435 E VENICE AVE UNIT 104
Mailing Address - Street 2:PMB #200
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34292-3074
Mailing Address - Country:US
Mailing Address - Phone:941-486-1930
Mailing Address - Fax:941-866-2626
Practice Address - Street 1:422 TRENTO DRIVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285
Practice Address - Country:US
Practice Address - Phone:941-486-1930
Practice Address - Fax:941-866-2626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY4642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73874Medicare PIN
NYR03984Medicare UPIN