Provider Demographics
NPI:1346295508
Name:BRYANT, MELISSA LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:LYNN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:APRN
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 917770
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-0001
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 LAKELAND HILLS BLVD
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33805-4544
Practice Address - Country:US
Practice Address - Phone:863-603-6542
Practice Address - Fax:863-603-6529
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2021-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1943122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY113MQOtherBCBS OF FLORIDA
FL1497748743OtherGROUP NPI NUMBER
FL012695900Medicaid
FLDA5786OtherRAILROAD MEDICARE GROUP NUMBER / LRHSI
FLY113MOtherBLUE CROSS BLUE SHIELD
FLP92545Medicare UPIN
FLY113MQOtherBCBS OF FLORIDA
FLU0920WMedicare PIN