Provider Demographics
NPI:1346294261
Name:BRYAN, MICHELLE L (ARNP)
Entity Type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:L
Last Name:BRYAN
Suffix:
Gender:F
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:PO BOX 637801
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-7801
Mailing Address - Country:US
Mailing Address - Phone:941-753-7585
Mailing Address - Fax:941-758-2153
Practice Address - Street 1:4319 20TH ST W
Practice Address - Street 2:SUITE 101
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-5000
Practice Address - Country:US
Practice Address - Phone:941-753-7585
Practice Address - Fax:941-758-2153
Is Sole Proprietor?:No
Enumeration Date:2006-05-22
Last Update Date:2014-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 3407102363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP37140Medicare UPIN
FLE5954YMedicare ID - Type Unspecified