1093174039 NPI number — DR. JOHN BRYAN SERRANO DNP, FNP-C,BSN, RNBC

Table of content: DR. JOHN BRYAN SERRANO DNP, FNP-C,BSN, RNBC (NPI 1093174039)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093174039 NPI number — DR. JOHN BRYAN SERRANO DNP, FNP-C,BSN, RNBC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SERRANO
Provider First Name:
JOHN BRYAN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DNP, FNP-C,BSN, RNBC
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1093174039
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4102 PINION DRIVE, 10TH MEDICAL GROUP
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
USAF ACADEMY
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80840-2502
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
719-333-5180
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15301 WARREN SHINGLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEALE AFB
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95903-1905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-634-4114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2016

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  239531 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com