Provider Demographics
NPI:1518539550
Name:BRYANT, NILAH (FNP)
Entity Type:Individual
Prefix:
First Name:NILAH
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:THABITA
Other - Middle Name:
Other - Last Name:GATSIMBANYI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2840 N DYSART RD
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85395-2338
Mailing Address - Country:US
Mailing Address - Phone:623-536-5309
Mailing Address - Fax:
Practice Address - Street 1:2840 N DYSART RD
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2338
Practice Address - Country:US
Practice Address - Phone:623-536-5309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-10
Last Update Date:2023-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ260573363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily