Provider Demographics
NPI:1194025510
Name:STAFFORD, BRYAN MICHAEL SR (ARNP)
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:MICHAEL
Last Name:STAFFORD
Suffix:SR
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13067 FELLOWSHIP LN
Mailing Address - Street 2:
Mailing Address - City:WEEKI WACHEE
Mailing Address - State:FL
Mailing Address - Zip Code:34614-2977
Mailing Address - Country:US
Mailing Address - Phone:352-593-4281
Mailing Address - Fax:
Practice Address - Street 1:8246 RIVER COUNTRY DR
Practice Address - Street 2:
Practice Address - City:WEEKI WACHEE
Practice Address - State:FL
Practice Address - Zip Code:34607-2101
Practice Address - Country:US
Practice Address - Phone:352-684-8637
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2016-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFL ARNP9209888363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily