Provider Demographics
NPI:1871350462
Name:BRYAN, NIKKI GIOVANNI (MS)
Entity type:Individual
Prefix:
First Name:NIKKI
Middle Name:GIOVANNI
Last Name:BRYAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 RIVER RIDGE DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32825-8744
Mailing Address - Country:US
Mailing Address - Phone:407-694-5934
Mailing Address - Fax:
Practice Address - Street 1:2837 RIVER RIDGE DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-8744
Practice Address - Country:US
Practice Address - Phone:407-694-5934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-01
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral