Individual
LISA BRYAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5015 29TH AVE W, BRADENTON, FL 34209-6119
(941) 795-4025
Mailing address
1801 51ST ST W, BRADENTON, FL 34209-5031
(941) 795-4025
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
AL10127
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140259500
—
FL
Enumeration date
08/26/2014
Last updated
08/26/2014
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