Provider Demographics
NPI:1417737305
Name:BRYANT, WHITLEY MIKAYLA (FNP)
Entity Type:Individual
Prefix:
First Name:WHITLEY
Middle Name:MIKAYLA
Last Name:BRYANT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:WHITLEY
Other - Middle Name:
Other - Last Name:DILLON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6029 WEDGEWOOD LN
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:FL
Mailing Address - Zip Code:32466-2776
Mailing Address - Country:US
Mailing Address - Phone:850-814-5026
Mailing Address - Fax:
Practice Address - Street 1:6029 WEDGEWOOD LN
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:FL
Practice Address - Zip Code:32466-2776
Practice Address - Country:US
Practice Address - Phone:850-814-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11028911363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily