MEDICARE: MELISSA LYNN BRYANT APRN

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	363L00000X	Nurse Practitioner	ARNP1943122	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	DA5786	OTHER	FL	RAILROAD MEDICARE GROUP NUMBER / LRHSI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	Y113MQ	OTHER	FL	BCBS OF FLORIDA
2	1497748743	OTHER	FL	GROUP NPI NUMBER
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	Y113M	OTHER	FL	BLUE CROSS BLUE SHIELD
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346295508
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA LYNN BRYANT APRN

Provider Business Mailing Address
First Line	:	PO BOX 917770
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32891-0001
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1325 LAKELAND HILLS BLVD
Second Line	:
City	:	LAKELAND
State	:	FL
Zip	:	33805-4544
Country	:	US
Telephone Number	:	863-603-6542
Fax Number	:	863-603-6529

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

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	02/22/2021

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