Healthcare Provider Details

I. General information

NPI: 1225355431
Provider Name (Legal Business Name): TIFFANY BRYANT MSN, RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2010
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

808 OAK AVE
GREENFIELD CA
93927-5648
US

IV. Provider business mailing address

6310 N MAIN ST
DAYTON OH
45415-3155
US

V. Phone/Fax

Practice location:
  • Phone: 831-674-5344
  • Fax:
Mailing address:
  • Phone: 937-270-0239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberCOA.17425-NP
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002547
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN341517
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: