Provider Demographics
NPI:1457773640
Name:CARREA, BRYANA (APN)
Entity Type:Individual
Prefix:
First Name:BRYANA
Middle Name:
Last Name:CARREA
Suffix:
Gender:F
Credentials:APN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8755
Mailing Address - Street 2:
Mailing Address - City:TURNERSVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08012-8755
Mailing Address - Country:US
Mailing Address - Phone:856-366-0100
Mailing Address - Fax:856-494-1314
Practice Address - Street 1:877 KINGS HWY STE 101
Practice Address - Street 2:
Practice Address - City:WEST DEPTFORD
Practice Address - State:NJ
Practice Address - Zip Code:08096-3167
Practice Address - Country:US
Practice Address - Phone:856-366-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-08
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NNJ01041600363LP0808X, 363LP0808X
DELG-0011774363LF0000X
NJ26NJ01041600363LF0000X
DEL8-0010493363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily