Provider Demographics
NPI:1346221249
Name:BRYANT, KAREN VONCILLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:VONCILLE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6885 BELFORT OAKS PL
Mailing Address - Street 2:SUITE 210
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6234
Mailing Address - Country:US
Mailing Address - Phone:904-652-0373
Mailing Address - Fax:904-653-0378
Practice Address - Street 1:6885 BELFORT OAKS PL
Practice Address - Street 2:SUITE 210
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-6234
Practice Address - Country:US
Practice Address - Phone:904-652-0373
Practice Address - Fax:904-653-0378
Is Sole Proprietor?:No
Enumeration Date:2005-11-08
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101268363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE4346ZMedicare ID - Type Unspecified
FLP10458Medicare UPIN