Provider Demographics
NPI:1972047496
Name:ZIMMERMAN, BRYAN
Entity Type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:
Last Name:ZIMMERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 CYPRESS HILL CIR
Mailing Address - Street 2:NONE
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-3672
Mailing Address - Country:US
Mailing Address - Phone:813-444-8413
Mailing Address - Fax:
Practice Address - Street 1:11811 CYPRESS HILL CIR
Practice Address - Street 2:NONE
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3672
Practice Address - Country:US
Practice Address - Phone:813-444-8413
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1174928931106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst