Provider Demographics
NPI:1760604920
Name:WEBB, BRYAN DAVID (DNP, AGPCNP-BC, RNFA)
Entity Type:Individual
Prefix:
First Name:BRYAN
Middle Name:DAVID
Last Name:WEBB
Suffix:
Gender:M
Credentials:DNP, AGPCNP-BC, RNFA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1058 N VICTORIA PARK RD
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-2414
Mailing Address - Country:US
Mailing Address - Phone:619-296-5959
Mailing Address - Fax:
Practice Address - Street 1:1058 N VICTORIA PARK RD
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33304-2414
Practice Address - Country:US
Practice Address - Phone:619-296-5959
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI725533363LA2200X
CA95004268363LA2200X, 363LP2300X, 364SG0600X
CA587728364SP2800X
FL11014466363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No364SP2800XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPerioperative