Provider Demographics
NPI:1215999164
Name:SUSAN BOCOCK RYALS
Entity type:Organization
Organization Name:SUSAN BOCOCK RYALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:BOCOCK
Authorized Official - Last Name:RYALS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-392-1161
Mailing Address - Street 1:8303 SW 152ND AVE
Mailing Address - Street 2:
Mailing Address - City:ARCHER
Mailing Address - State:FL
Mailing Address - Zip Code:32618-4462
Mailing Address - Country:US
Mailing Address - Phone:352-495-9085
Mailing Address - Fax:
Practice Address - Street 1:1 FLETCHER DR
Practice Address - Street 2:SHCC,
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-7500
Practice Address - Country:US
Practice Address - Phone:352-392-1161
Practice Address - Fax:352-846-1089
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL616462261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center