Provider Demographics
NPI:1821776667
Name:BRYANT, EDWARD LEE JR (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:LEE
Last Name:BRYANT
Suffix:JR
Gender:M
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13736 CHAUVIN AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-3810
Mailing Address - Country:US
Mailing Address - Phone:631-256-6111
Mailing Address - Fax:
Practice Address - Street 1:2710 REW CIR
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-2967
Practice Address - Country:US
Practice Address - Phone:631-256-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-11
Last Update Date:2023-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9440992163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse