Provider Demographics
NPI:1053652800
Name:BRYANT, JUNE S (ARNP)
Entity Type:Individual
Prefix:
First Name:JUNE
Middle Name:S
Last Name:BRYANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10615 BOYETTE CREEK BLVD
Mailing Address - Street 2:
Mailing Address - City:RIVERVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:33569-2721
Mailing Address - Country:US
Mailing Address - Phone:941-538-2118
Mailing Address - Fax:
Practice Address - Street 1:10036 WATER WORKS LN
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:FL
Practice Address - Zip Code:33578-5301
Practice Address - Country:US
Practice Address - Phone:813-671-1872
Practice Address - Fax:813-671-1056
Is Sole Proprietor?:No
Enumeration Date:2013-03-04
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9287256363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL100212600Medicaid