Healthcare Provider Details

I. General information

NPI: 1043016546
Provider Name (Legal Business Name): BRYANNA MAUK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2025
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

775 WOODRUFF RD STE 2A
GREENVILLE SC
29607-3558
US

IV. Provider business mailing address

775 WOODRUFF RD STE 2A
GREENVILLE SC
29607-3558
US

V. Phone/Fax

Practice location:
  • Phone: 803-999-1750
  • Fax:
Mailing address:
  • Phone: 864-546-0545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30028
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: