Provider Demographics
NPI:1730789926
Name:BRYAN, JENNIFER P (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:P
Last Name:BRYAN
Suffix:
Gender:F
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 FERN AVE
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37419-2002
Mailing Address - Country:US
Mailing Address - Phone:423-505-4993
Mailing Address - Fax:
Practice Address - Street 1:725 GLENWOOD DR STE E790
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37404-1178
Practice Address - Country:US
Practice Address - Phone:423-206-4140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-10-28
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN284512084N0400X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology