Provider Demographics
NPI:1528536174
Name:GWALTNEY, BRIANA (APRN)
Entity type:Individual
Prefix:
First Name:BRIANA
Middle Name:
Last Name:GWALTNEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 JORDAN LN STE 3
Mailing Address - Street 2:
Mailing Address - City:WETHERSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06109-1244
Mailing Address - Country:US
Mailing Address - Phone:860-263-0253
Mailing Address - Fax:860-263-0262
Practice Address - Street 1:160 HAZARD AVE STE 103
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5437
Practice Address - Country:US
Practice Address - Phone:860-962-6600
Practice Address - Fax:860-962-6866
Is Sole Proprietor?:No
Enumeration Date:2018-11-12
Last Update Date:2025-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9355568363LF0000X
CT14658363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP9355568OtherPROFESSIONAL LICENSURE
NH3120790Medicaid
VT6700634Medicaid