Healthcare Provider Details

I. General information

NPI: 1760071211
Provider Name (Legal Business Name): LENNAYA SHARVAE BRYAN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2021
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR
OCOEE FL
34761-3400
US

IV. Provider business mailing address

10000 W COLONIAL DR
OCOEE FL
34761-3400
US

V. Phone/Fax

Practice location:
  • Phone: 218-431-3783
  • Fax: 321-843-5177
Mailing address:
  • Phone: 218-431-3783
  • Fax: 321-843-5177

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11004974
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11004974
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: