MEDICARE: ANGELA MARIA BRYANT FNP-C

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	363LF0000X	Family Nurse Practitioner	5015682	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NONE	OTHER		NONE

General Provider Information

NPI Number	:	1518610997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA MARIA BRYANT FNP-C

Provider Business Mailing Address
First Line	:	123 SUNNYBROOK RD STE 120
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-2784
Country	:	US
Telephone Number	:	919-231-6073
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 SUNNYBROOK RD
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27610-2783
Country	:	US
Telephone Number	:	919-231-6073
Fax Number	:

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

Provider Enumeration Date	:	01/27/2022
Last Update Date	:	01/27/2025

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