Provider Demographics
NPI:1245254408
Name:RYAN, DELTA (PA)
Entity type:Individual
Prefix:
First Name:DELTA
Middle Name:
Last Name:RYAN
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:5426 CHARLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33810-8236
Mailing Address - Country:US
Mailing Address - Phone:863-859-5611
Mailing Address - Fax:727-507-3618
Practice Address - Street 1:1324 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4543
Practice Address - Country:US
Practice Address - Phone:863-687-1132
Practice Address - Fax:863-687-1439
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLPA2714363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P19600Medicare UPIN