Provider Demographics
NPI:1528536174
Name:GWALTNEY, BRIANA (APRN)
Entity Type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 CORTONA DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32828-6746
Mailing Address - Country:US
Mailing Address - Phone:813-504-8543
Mailing Address - Fax:
Practice Address - Street 1:28 BELMONT AVE
Practice Address - Street 2:
Practice Address - City:BRATTLEBORO
Practice Address - State:VT
Practice Address - Zip Code:05301-6654
Practice Address - Country:US
Practice Address - Phone:802-251-8720
Practice Address - Fax:802-251-8721
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9355568363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3120790Medicaid
VT6700634Medicaid
FLARNP9355568OtherPROFESSIONAL LICENSURE