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General NPI Number Information
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NPI Number | 1477178747
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Entity Type | Individual
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Provider Name | NYKIA-GEORGE ANTHEA BRYAN
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Gender | Female
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Dates
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Enumeration Date | 06/12/2020
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Last Update Date | 07/04/2024
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Provider Practice Location Address
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Address Line | 12500 S APOPKA VINELAND RD
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City | ORLANDO
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State | FL
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Zip | 32836-6723
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Country | US
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Telephone | 407-934-2273
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Fax |
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Provider Business Mailing Address
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Address Line | 2384 SENTRY PALM DR APT 113
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City | APOPKA
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State | FL
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Zip | 32703-0055
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Country | US
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Telephone | 352-509-0087
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 9113144
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License Number State | FL
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