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General NPI Number Information
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NPI Number | 1881117323
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Entity Type | Individual
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Provider Name | BRYAN CHRISTOPHER WISNIEWSKI ARNP
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Gender | Male
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7005 NIGHTWALKER RD
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City | WEEKI WACHEE
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State | FL
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Zip | 34613-6349
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Country | US
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Telephone | 727-807-2476
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Fax |
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Provider Business Mailing Address
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Address Line | 7005 NIGHTWALKER ROAD
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City | BROOKSVILLE
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State | FL
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Zip | 34613
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Country | US
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Telephone | 727-807-2476
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP9319025
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License Number State | FL
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