Provider Demographics
NPI:1932870524
Name:BRYCEN, JOSHUA
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:BRYCEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6321 DANIELS PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33912-4773
Mailing Address - Country:US
Mailing Address - Phone:844-384-8333
Mailing Address - Fax:855-979-5701
Practice Address - Street 1:1800 2ND ST STE 735
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34236-5966
Practice Address - Country:US
Practice Address - Phone:888-708-0561
Practice Address - Fax:404-585-2688
Is Sole Proprietor?:No
Enumeration Date:2021-09-23
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT12835792-4405363LF0000X
FL11015189363LF0000X
MN9863363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily