Healthcare Provider Details

I. General information

NPI: 1700711199
Provider Name (Legal Business Name): TERRILL JAYNE BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

3491 NICHOLSON ESTATES RD
PACE FL
32571-9440
US

IV. Provider business mailing address

11662 WAKEFIELD DR
PENSACOLA FL
32514-9744
US

V. Phone/Fax

Practice location:
  • Phone: 850-503-3010
  • Fax:
Mailing address:
  • Phone: 850-261-3845
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: