Provider Demographics
NPI:1225355431
Name:BRYANT, TIFFANY (MSN, RN, FNP-C)
Entity type:Individual
Prefix:
First Name:TIFFANY
Middle Name:
Last Name:BRYANT
Suffix:
Gender:F
Credentials:MSN, RN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6310 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45415-3155
Mailing Address - Country:US
Mailing Address - Phone:937-270-0239
Mailing Address - Fax:
Practice Address - Street 1:6310 N MAIN ST
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45415-3155
Practice Address - Country:US
Practice Address - Phone:937-270-0239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-27
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN341517163W00000X
CA95002547363LF0000X
OHCOA.17425-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0099657Medicaid