Provider Demographics
NPI:1063924736
Name:BRYAN, TIJANA (MMS, PA-C)
Entity type:Individual
Prefix:
First Name:TIJANA
Middle Name:
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MMS, PA-C
Other - Prefix:
Other - First Name:TIJANA
Other - Middle Name:
Other - Last Name:POPOVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 N GARY AVE
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-3264
Mailing Address - Country:US
Mailing Address - Phone:630-416-4501
Mailing Address - Fax:
Practice Address - Street 1:2001 N GARY AVE
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60187-3264
Practice Address - Country:US
Practice Address - Phone:630-416-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-02
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.006429363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical