MEDICARE: STEPHANIE MICHELLE BRYANT

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	363LF0000X	Family Nurse Practitioner	APRN11016589	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720749807
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE MICHELLE BRYANT

Provider Business Mailing Address
First Line	:	225 CYAN AVE
Second Line	:
City	:	DAYTONA BEACH
State	:	FL
Zip	:	32124-3695
Country	:	US
Telephone Number	:	386-679-2317
Fax Number	:

Provider Business Practice Location Address
First Line	:	317 S DIXIE FWY
Second Line	:
City	:	NEW SMYRNA BEACH
State	:	FL
Zip	:	32168-7158
Country	:	US
Telephone Number	:	386-424-1414
Fax Number	:

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

Provider Enumeration Date	:	01/01/2022
Last Update Date	:	01/01/2022

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