Provider Demographics
NPI:1477178747
Name:BRYAN, NYKIA-GEORGE ANTHEA
Entity Type:Individual
Prefix:
First Name:NYKIA-GEORGE
Middle Name:ANTHEA
Last Name:BRYAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1710 NW 19TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34475-4989
Mailing Address - Country:US
Mailing Address - Phone:352-509-0087
Mailing Address - Fax:
Practice Address - Street 1:1710 NW 19TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34475-4989
Practice Address - Country:US
Practice Address - Phone:352-509-0087
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9113144363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant