Provider Demographics
NPI:1619413085
Name:BARRETT-BRYANT, SONIA (LPN)
Entity type:Individual
Prefix:
First Name:SONIA
Middle Name:
Last Name:BARRETT-BRYANT
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2408 CENTENNIAL BLVD
Mailing Address - Street 2:
Mailing Address - City:LEESBURG
Mailing Address - State:FL
Mailing Address - Zip Code:34748-3220
Mailing Address - Country:US
Mailing Address - Phone:352-457-6671
Mailing Address - Fax:
Practice Address - Street 1:2408 CENTENNIAL BLVD
Practice Address - Street 2:
Practice Address - City:LEESBURG
Practice Address - State:FL
Practice Address - Zip Code:34748-3220
Practice Address - Country:US
Practice Address - Phone:352-457-6671
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2017-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5192191374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPN5192191OtherNURSING LICENSE