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NPI Code Detail

MEDICARE: CHRISTINA BRYAN BA

MEDICARE: CHRISTINA BRYAN BA
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
1104100000XSocial Worker

General Provider Information

NPI Number : 1982963971
Entity Type Code : Individual
Provider Name (Legal Business Name) : CHRISTINA BRYAN BA
Provider Business Mailing Address
First Line : 2814 S US HIGHWAY 1 STE D4
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-8110
Country : US
Telephone Number : 772-489-4726
Fax Number : 772-489-0423
Provider Business Practice Location Address
First Line : 2814 S US HIGHWAY 1 STE D4
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-8110
Country : US
Telephone Number : 772-489-4726
Fax Number : 772-489-0423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/10/2012
Last Update Date : 05/10/2012

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1417216532 — SARAH NIEMINEN
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1548529522 — JOHN JAMES SABO PH,D
Practice Location Address:
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Directions to “ CHRISTINA BRYAN BA” Practice Location

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