Provider Demographics
NPI:1619583309
Name:BRYANT, MERLEN CARIDAD
Entity Type:Individual
Prefix:
First Name:MERLEN
Middle Name:CARIDAD
Last Name:BRYANT
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 1:4340 E 9TH CT
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33013-2428
Mailing Address - Country:US
Mailing Address - Phone:561-601-7157
Mailing Address - Fax:
Practice Address - Street 1:4340 EAST 9 COURT
Practice Address - Street 2:HIALEAH
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33013-3301
Practice Address - Country:US
Practice Address - Phone:561-601-7157
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-18
Last Update Date:2020-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11008857364SF0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily Health