MEDICARE: CLARA G BRYANT CNA

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	376K00000X	Nurse's Aide	18069	FL

General Provider Information

NPI Number	:	1720577414
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CLARA G BRYANT CNA

Provider Business Mailing Address
First Line	:	4590 39TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-6385
Country	:	US
Telephone Number	:	772-532-4484
Fax Number	:	772-774-8168

Provider Business Practice Location Address
First Line	:	4590 39TH AVE
Second Line	:
City	:	VERO BEACH
State	:	FL
Zip	:	32967-6385
Country	:	US
Telephone Number	:	772-532-4484
Fax Number	:	772-774-8168

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

Provider Enumeration Date	:	05/08/2018
Last Update Date	:	05/08/2018

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