Provider Demographics
NPI:1306026877
Name:BRYANT, BARBARA L (APRN)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:L
Last Name:BRYANT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:BARBARA
Other - Middle Name:L
Other - Last Name:BRYANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:APRN PMHNP-BC
Mailing Address - Street 1:10585 165TH ST W
Mailing Address - Street 2:
Mailing Address - City:LAKEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55044-3531
Mailing Address - Country:US
Mailing Address - Phone:952-955-4110
Mailing Address - Fax:952-955-7482
Practice Address - Street 1:960 NW FRESCO WAY APT 202
Practice Address - Street 2:
Practice Address - City:JENSEN BEACH
Practice Address - State:FL
Practice Address - Zip Code:34957-3546
Practice Address - Country:US
Practice Address - Phone:941-204-3743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-13
Last Update Date:2023-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNCNP7974363LP0808X, 2084P0800X, 363L00000X
WAAP60485709207QS0010X
FLARNP9268672363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNCNP7974OtherMN LICENSE
FLARNP9268672OtherLICENSE