Healthcare Provider Details

I. General information

NPI: 1790640795
Provider Name (Legal Business Name): BRYANA NGUYEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2025
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 NW 43RD ST STE E2
GAINESVILLE FL
32606-8134
US

IV. Provider business mailing address

13816 TYBEE BEACH LN
ORLANDO FL
32827-7953
US

V. Phone/Fax

Practice location:
  • Phone: 703-304-4918
  • Fax:
Mailing address:
  • Phone: 703-304-4918
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMH27033
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: