Provider Demographics
NPI:1740739671
Name:BRYANT, ALEXIS
Entity Type:Individual
Prefix:
First Name:ALEXIS
Middle Name:
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 1:16913 LAKESIDE DR
Mailing Address - Street 2:SUITE 11
Mailing Address - City:MONTVERDE
Mailing Address - State:FL
Mailing Address - Zip Code:34756-3230
Mailing Address - Country:US
Mailing Address - Phone:407-544-2351
Mailing Address - Fax:
Practice Address - Street 1:16913 LAKESIDE DR
Practice Address - Street 2:SUITE 11
Practice Address - City:MONTVERDE
Practice Address - State:FL
Practice Address - Zip Code:34756-3230
Practice Address - Country:US
Practice Address - Phone:407-544-2351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-04
Last Update Date:2016-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ZZ376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide