Provider Demographics
NPI:1659751709
Name:LEAST, RYNE (PA-C)
Entity Type:Individual
Prefix:
First Name:RYNE
Middle Name:
Last Name:LEAST
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 MERCHANTS ROW BLVD APT 816
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32311-4719
Mailing Address - Country:US
Mailing Address - Phone:859-753-0422
Mailing Address - Fax:
Practice Address - Street 1:1690 N MONROE ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-5533
Practice Address - Country:US
Practice Address - Phone:850-385-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYAT1206172V00000X
FLPA9111471363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No172V00000XOther Service ProvidersCommunity Health Worker