Provider Demographics
NPI:1063182194
Name:GAVAGNI FIORENTINO, RYAN KELSEY (ARNP)
Entity type:Individual
Prefix:MS
First Name:RYAN
Middle Name:KELSEY
Last Name:GAVAGNI FIORENTINO
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 DORRIT AVE
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-2734
Mailing Address - Country:US
Mailing Address - Phone:561-601-4976
Mailing Address - Fax:
Practice Address - Street 1:1001 NW 13TH ST
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2269
Practice Address - Country:US
Practice Address - Phone:561-300-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-20
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9337753163WX0003X
FLARNP11016760367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
No163WX0003XNursing Service ProvidersRegistered NurseObstetric, Inpatient