Provider Demographics
NPI:1598810947
Name:BRYANT, WANDA MARIE (ARNP)
Entity Type:Individual
Prefix:
First Name:WANDA
Middle Name:MARIE
Last Name:BRYANT
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:WANDA
Other - Middle Name:MARIE
Other - Last Name:BLANCHARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4802 CHARRO LN
Mailing Address - Street 2:
Mailing Address - City:PLANT CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33565-3610
Mailing Address - Country:US
Mailing Address - Phone:813-982-0999
Mailing Address - Fax:
Practice Address - Street 1:601 BROOKER CREEK BLVD
Practice Address - Street 2:
Practice Address - City:OLDSMAR
Practice Address - State:FL
Practice Address - Zip Code:34677-2962
Practice Address - Country:US
Practice Address - Phone:813-294-9031
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2995732363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology