MEDICARE: BARBARA L BRYANT APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	CNP7974	MN
2	207QS0010X	Sports Medicine (Family Medicine) Physician	AP60485709	WA
3	2084P0800X	Psychiatry Physician	CNP7974	MN
4	363LF0000X	Family Nurse Practitioner	ARNP9268672	FL
5	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	ARNP9268672	FL
6	363L00000X	Nurse Practitioner	CNP7974	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CNP7974	OTHER	MN	MN LICENSE
2	ARNP9268672	OTHER	FL	LICENSE

General Provider Information

NPI Number	:	1306026877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BARBARA L BRYANT APRN

Provider Business Mailing Address
First Line	:	10585 165TH ST W
Second Line	:
City	:	LAKEVILLE
State	:	MN
Zip	:	55044-3531
Country	:	US
Telephone Number	:	952-955-4110
Fax Number	:	952-955-7482

Provider Business Practice Location Address
First Line	:	960 NW FRESCO WAY APT 202
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3546
Country	:	US
Telephone Number	:	941-204-3743
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/13/2007
Last Update Date	:	02/08/2023

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Directions to “ BARBARA L BRYANT APRN” Practice Location

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