Provider Demographics
NPI:1346819950
Name:BRYANT, JENNIFER LEE (FNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LEE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9608 BOUNDLESS SHADE TER
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1490
Mailing Address - Country:US
Mailing Address - Phone:443-774-8259
Mailing Address - Fax:
Practice Address - Street 1:9608 BOUNDLESS SHADE TER
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1490
Practice Address - Country:US
Practice Address - Phone:443-774-8259
Practice Address - Fax:443-214-0542
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-18
Last Update Date:2024-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR238476363LF0000X, 163WC1500X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD88-3395270Other88-3395270