Basic Information
| Provider Information | |||||||||
| NPI: | 1831835412 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRYAN | ||||||||
| FirstName: | TATIANA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 121 DANUBE AVE APT 204 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336063528 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8135458331 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2005 PAN AM CIR STE 120 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336072529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273866495 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/07/2022 | ||||||||
| LastUpdateDate: | 05/07/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.