Provider Demographics
NPI:1164528618
Name:BRYAN, TRACI ELIZABETH (CRNA)
Entity type:Individual
Prefix:
First Name:TRACI
Middle Name:ELIZABETH
Last Name:BRYAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:TRACI
Other - Middle Name:ELIZABETH
Other - Last Name:COWART
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:88 SOMERSET LN
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-6653
Mailing Address - Country:US
Mailing Address - Phone:770-789-6220
Mailing Address - Fax:
Practice Address - Street 1:823 CAMPBELL HILL ST NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30060-1144
Practice Address - Country:US
Practice Address - Phone:678-203-6711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-15
Last Update Date:2025-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN077540367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered