Healthcare Provider Details

I. General information

NPI: 1932177557
Provider Name (Legal Business Name): CYNTHIA BLACKWELL BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2006
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4970 HIGHWAY 90
MARIANNA FL
32446-6802
US

IV. Provider business mailing address

4970 HIGHWAY 90
MARIANNA FL
32446-6802
US

V. Phone/Fax

Practice location:
  • Phone: 850-718-5620
  • Fax: 850-706-3996
Mailing address:
  • Phone: 850-718-5620
  • Fax: 850-706-3996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME80397
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: