Provider Demographics
NPI:1407247224
Name:BRYANT, LATANYA D (CRNP)
Entity Type:Individual
Prefix:MRS
First Name:LATANYA
Middle Name:D
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CRNP
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 91899
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36691-1899
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:32 TACON ST
Practice Address - Street 2:STE A
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36607-3138
Practice Address - Country:US
Practice Address - Phone:251-706-8170
Practice Address - Fax:251-706-8098
Is Sole Proprietor?:No
Enumeration Date:2015-02-16
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-089473363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily