Provider Demographics
NPI:1992367544
Name:RYAN, CORINNE MARIE (APRN)
Entity Type:Individual
Prefix:
First Name:CORINNE
Middle Name:MARIE
Last Name:RYAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 REGENCY SQUARE BLVD STE 903
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32225-8116
Mailing Address - Country:US
Mailing Address - Phone:561-523-9392
Mailing Address - Fax:904-329-2349
Practice Address - Street 1:9550 REGENCY SQUARE BLVD STE 903
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32225-8116
Practice Address - Country:US
Practice Address - Phone:561-523-9392
Practice Address - Fax:904-329-2349
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-03
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11003066363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAPRN11003066OtherAPRN
FL2019043970OtherANCC