Provider Demographics
NPI:1922622778
Name:NAVARRE, RYAN D'ARMOND (PA-C)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:D'ARMOND
Last Name:NAVARRE
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 1:1023 SARANAC PARK
Mailing Address - Street 2:
Mailing Address - City:PEACHTREE CITY
Mailing Address - State:GA
Mailing Address - Zip Code:30269-1274
Mailing Address - Country:US
Mailing Address - Phone:404-309-2124
Mailing Address - Fax:
Practice Address - Street 1:100 MAGNOLIA ST APT 6213
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-2257
Practice Address - Country:US
Practice Address - Phone:404-309-2124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-07
Last Update Date:2022-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL390200000X
FLPA9113407363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program