Provider Demographics
NPI:1215584818
Name:BRYANT, NELSON MCNOVA (FNP-C, PHD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:MCNOVA
Last Name:BRYANT
Suffix:
Gender:M
Credentials:FNP-C, PHD
Other - Prefix:DR
Other - First Name:NELSON
Other - Middle Name:
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP-C
Mailing Address - Street 1:7252 W ST CATHERINE AVE
Mailing Address - Street 2:
Mailing Address - City:LAVEEN
Mailing Address - State:AZ
Mailing Address - Zip Code:85339-2693
Mailing Address - Country:US
Mailing Address - Phone:480-788-0240
Mailing Address - Fax:
Practice Address - Street 1:7252 W ST CATHERINE AVE
Practice Address - Street 2:
Practice Address - City:LAVEEN
Practice Address - State:AZ
Practice Address - Zip Code:85339
Practice Address - Country:US
Practice Address - Phone:480-788-0240
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-20
Last Update Date:2024-04-10
Deactivation Date:2021-11-11
Deactivation Code:
Reactivation Date:2021-12-01
Provider Licenses
StateLicense IDTaxonomies
AZ221085363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily