Healthcare Provider Details

I. General information

NPI: 1679444293
Provider Name (Legal Business Name): TANNICE S BRYAN BSN, RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2025
Last Update Date: 09/26/2025
Certification Date: 09/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 LAKEVILLE RD
NEW HYDE PARK NY
11042-1121
US

IV. Provider business mailing address

12 CYPRESS RD
INWOOD NY
11096-1710
US

V. Phone/Fax

Practice location:
  • Phone: 718-603-1356
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0106X
TaxonomyOccupational Health Registered Nurse
License Number747320-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: