Provider Demographics
NPI:1053292854
Name:NETTLES, BRIANNA (FNP-BC)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:NETTLES
Suffix:
Gender:F
Credentials: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:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:FL
Mailing Address - Zip Code:32046-0534
Mailing Address - Country:US
Mailing Address - Phone:904-557-4260
Mailing Address - Fax:
Practice Address - Street 1:3026 GA-252 E
Practice Address - Street 2:
Practice Address - City:FOLKSTON
Practice Address - State:GA
Practice Address - Zip Code:31537
Practice Address - Country:US
Practice Address - Phone:912-496-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-09
Last Update Date:2025-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GANP003916363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner