Individual
RYAN ALEXANDER NELSON
Active
Individual
RYAN ALEXANDER NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
12496
MN
363AM0700X
Medical Physician Assistant
Primary
PA9113002
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
108562100
—
FL
01
—
QIJMQ
BCBS
FL
Enumeration date
05/11/2017
Last updated
01/08/2025
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