Provider Demographics
NPI:1538149992
Name:BRYANT, SANDRA DIANN (CRNA)
Entity type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:DIANN
Last Name:BRYANT
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5890 NE 65TH ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34488-1129
Mailing Address - Country:US
Mailing Address - Phone:352-438-2281
Mailing Address - Fax:352-438-2281
Practice Address - Street 1:800 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-6209
Practice Address - Country:US
Practice Address - Phone:352-338-2112
Practice Address - Fax:352-328-6799
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-20
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9189851367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305825500Medicaid
FL63327Medicare ID - Type Unspecified