Provider Demographics
NPI:1588095913
Name:CARRICO, BRYAN ALOYSIUS (CRNA)
Entity type:Individual
Prefix:MR
First Name:BRYAN
Middle Name:ALOYSIUS
Last Name:CARRICO
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:622 EYAM HALL LN
Mailing Address - Street 2:
Mailing Address - City:APEX
Mailing Address - State:NC
Mailing Address - Zip Code:27502-4760
Mailing Address - Country:US
Mailing Address - Phone:786-797-9911
Mailing Address - Fax:919-578-1511
Practice Address - Street 1:622 EYAM HALL LN
Practice Address - Street 2:
Practice Address - City:APEX
Practice Address - State:NC
Practice Address - Zip Code:27502-4760
Practice Address - Country:US
Practice Address - Phone:786-797-9911
Practice Address - Fax:919-578-1511
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC217589367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered