Provider Demographics
NPI:1184298762
Name:BRYAN, JANICE A (BA,MA,HHA)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:A
Last Name:BRYAN
Suffix:
Gender:F
Credentials:BA,MA,HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 LAGO CIR APT 100
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32904-3343
Mailing Address - Country:US
Mailing Address - Phone:321-368-0136
Mailing Address - Fax:
Practice Address - Street 1:200 LAGO CIR APT 100
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32904-3343
Practice Address - Country:US
Practice Address - Phone:321-368-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide