Provider Demographics
NPI:1801950282
Name:BRYNIARSKI, CAROL ANN (NURSE PRACTITIONER)
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:ANN
Last Name:BRYNIARSKI
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7561 E LA CIENEGA DR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85715-3526
Mailing Address - Country:US
Mailing Address - Phone:520-733-1537
Mailing Address - Fax:520-886-2369
Practice Address - Street 1:2122 N CRAYCROFT RD
Practice Address - Street 2:SUITE 102
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2849
Practice Address - Country:US
Practice Address - Phone:520-722-2400
Practice Address - Fax:520-323-7531
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZCERTIFICATE NO. 17363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ527509Medicaid
AZMB0011231OtherDEA #
AZS55838Medicare UPIN