Healthcare Provider Details

I. General information

NPI: 1851208300
Provider Name (Legal Business Name): BRIANNA LEIGH NINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2026
Last Update Date: 10/11/2026
Certification Date: 10/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 CHURCH ST N
CONCORD NC
28025-2927
US

IV. Provider business mailing address

315 MEDICAL PARK DR STE 202
CONCORD NC
28025-2973
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-3000
  • Fax:
Mailing address:
  • Phone: 704-403-1901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number5025688
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: