Provider Demographics
NPI:1972060101
Name:BURRIS, RYAN N (APRN)
Entity type:Individual
Prefix:MR
First Name:RYAN
Middle Name:N
Last Name:BURRIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4032 GREENWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-6151
Mailing Address - Country:US
Mailing Address - Phone:321-436-7910
Mailing Address - Fax:
Practice Address - Street 1:490 CENTRE LAKE DR NE STE 200
Practice Address - Street 2:
Practice Address - City:PALM BAY
Practice Address - State:FL
Practice Address - Zip Code:32907-1189
Practice Address - Country:US
Practice Address - Phone:321-821-4950
Practice Address - Fax:321-821-4955
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-25
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLF12180515363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care