Provider Demographics
NPI:1730823261
Name:SPEAKER, RYAN JOSEPH (REGISTERED NURSE)
Entity type:Individual
Prefix:
First Name:RYAN
Middle Name:JOSEPH
Last Name:SPEAKER
Suffix:
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 QUANTUM LAKES DR APT 102
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-8441
Mailing Address - Country:US
Mailing Address - Phone:502-526-6285
Mailing Address - Fax:
Practice Address - Street 1:2300 QUANTUM LAKES DR APT 102
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-8441
Practice Address - Country:US
Practice Address - Phone:502-526-6285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-21
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1155428163WC0200X, 163WE0003X, 163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered Nurse
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WE0003XNursing Service ProvidersRegistered NurseEmergencyGroup - Multi-Specialty