MEDICARE: TRACY BRYANT REGISTERED NURSE

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	163W00000X	Registered Nurse	237665	SC

General Provider Information

NPI Number	:	1790641678
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY BRYANT REGISTERED NURSE

Provider Business Mailing Address
First Line	:	35 COBDEN CT
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-6890
Country	:	US
Telephone Number	:	803-741-8433
Fax Number	:

Provider Business Practice Location Address
First Line	:	6729 TWO NOTCH RD STE M1018
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29223-7535
Country	:	US
Telephone Number	:	803-741-8433
Fax Number	:

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

Provider Enumeration Date	:	01/05/2026
Last Update Date	:	01/05/2026

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Directions to “ TRACY BRYANT REGISTERED NURSE” Practice Location

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