Provider Demographics
NPI:1336912989
Name:BRYANT, TRACY D (CNA)
Entity Type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:D
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11073 LAGUNA BAY DR APT 116
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32821-5567
Mailing Address - Country:US
Mailing Address - Phone:407-300-5106
Mailing Address - Fax:
Practice Address - Street 1:11073 LAGUNA BAY DR APT 116
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32821-5567
Practice Address - Country:US
Practice Address - Phone:407-300-5106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL186030376K00000X
AL186030376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide