Healthcare Provider Details

I. General information

NPI: 1447891965
Provider Name (Legal Business Name): BRYAN A WEBER PHD, APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2019
Last Update Date: 10/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4516 NW 36TH TER
GAINESVILLE FL
32605-5431
US

IV. Provider business mailing address

4516 NW 36TH TER
GAINESVILLE FL
32605-5431
US

V. Phone/Fax

Practice location:
  • Phone: 352-222-0359
  • Fax:
Mailing address:
  • Phone: 352-222-0359
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WI0600X
TaxonomyInfection Control Registered Nurse
License NumberAPRN9179205
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberAPRN9179205
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN9179205
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: