Healthcare Provider Details

I. General information

NPI: 1215867049
Provider Name (Legal Business Name): BRIANNA NICOLE LLOYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 N MAIN ST
CEDARVILLE OH
45314
US

IV. Provider business mailing address

9019 BLUEJAY LN
MENTOR OH
44060-1803
US

V. Phone/Fax

Practice location:
  • Phone: 937-766-7700
  • Fax:
Mailing address:
  • Phone: 440-391-7079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number496693
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: