Provider Demographics
NPI:1447891965
Name:WEBER, BRYAN A (PHD, APRN)
Entity type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:A
Last Name:WEBER
Suffix:
Gender:M
Credentials:PHD, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4516 NW 36TH TER
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32605-5431
Mailing Address - Country:US
Mailing Address - Phone:352-222-0359
Mailing Address - Fax:
Practice Address - Street 1:4516 NW 36TH TER
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32605-5431
Practice Address - Country:US
Practice Address - Phone:352-222-0359
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-06
Last Update Date:2019-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9179205163WI0600X, 163WH0200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WI0600XNursing Service ProvidersRegistered NurseInfection ControlGroup - Single Specialty
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty