Healthcare Provider Details

I. General information

NPI: 1649053414
Provider Name (Legal Business Name): MS. ALYSHA TENAGH BRYANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2023
Last Update Date: 10/31/2023
Certification Date: 08/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2906 17TH ST
SAINT CLOUD FL
34769-6006
US

IV. Provider business mailing address

7516 HUNTERS GREENE CIR
LAKELAND FL
33810-5215
US

V. Phone/Fax

Practice location:
  • Phone: 321-841-7856
  • Fax: 321-843-6432
Mailing address:
  • Phone: 410-972-6789
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LC0200X
TaxonomyCritical Care Medicine Nurse Practitioner
License Number11028261
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11028261
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: