Healthcare Provider Details

I. General information

NPI: 1164357687
Provider Name (Legal Business Name): SUSAN ROSEMARIE BRYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1800 MERCY DR
ORLANDO FL
32808-5646
US

IV. Provider business mailing address

5151 ADANSON ST
ORLANDO FL
32804-1317
US

V. Phone/Fax

Practice location:
  • Phone: 407-875-3740
  • Fax:
Mailing address:
  • Phone: 407-875-3700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number11036561
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: