MEDICARE: EDWARD LEE BRYANT JR. REGISTERED NURSE

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	163W00000X	Registered Nurse	RN9440992	FL

General Provider Information

NPI Number	:	1821776667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD LEE BRYANT JR. REGISTERED NURSE

Provider Business Mailing Address
First Line	:	13736 CHAUVIN AVE
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-3810
Country	:	US
Telephone Number	:	631-256-6111
Fax Number	:

Provider Business Practice Location Address
First Line	:	2710 REW CIR
Second Line	:
City	:	OCOEE
State	:	FL
Zip	:	34761-2967
Country	:	US
Telephone Number	:	631-256-6111
Fax Number	:

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

Provider Enumeration Date	:	07/11/2023
Last Update Date	:	07/11/2023

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