Provider Demographics
NPI:1093174039
Name:SERRANO, JOHN BRYAN (DNP, FNP-C,BSN, RNBC)
Entity Type:Individual
Prefix:MR
First Name:JOHN BRYAN
Middle Name:
Last Name:SERRANO
Suffix:
Gender:M
Credentials:DNP, FNP-C,BSN, RNBC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4102 PINION DRIVE, 10TH MEDICAL GROUP
Mailing Address - Street 2:
Mailing Address - City:USAF ACADEMY
Mailing Address - State:CO
Mailing Address - Zip Code:80840-2502
Mailing Address - Country:US
Mailing Address - Phone:719-333-5180
Mailing Address - Fax:
Practice Address - Street 1:4102 PINION DRIVE, 10TH MEDICAL GROUP
Practice Address - Street 2:
Practice Address - City:USAF ACADEMY
Practice Address - State:CO
Practice Address - Zip Code:80840-2502
Practice Address - Country:US
Practice Address - Phone:719-333-5180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-18
Last Update Date:2020-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ239531363LF0000X, 171000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171000000XOther Service ProvidersMilitary Health Care Provider
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily