MEDICARE: MIRANDA JO BRYANT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN11045107	FL

General Provider Information

NPI Number	:	1134078793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRANDA JO BRYANT

Provider Business Mailing Address
First Line	:	1136 MERION DR
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-8724
Country	:	US
Telephone Number	:	207-249-9121
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 N DONNELLY ST STE 11
Second Line	:
City	:	MOUNT DORA
State	:	FL
Zip	:	32757-4835
Country	:	US
Telephone Number	:	207-249-9121
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	01/27/2026

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