Healthcare Provider Details

I. General information

NPI: 1861330961
Provider Name (Legal Business Name): MAGEN RENEE PURVIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 3RD AVE W STE 210
BRADENTON FL
34205-8633
US

IV. Provider business mailing address

PO BOX 2821
ONECO FL
34264-2821
US

V. Phone/Fax

Practice location:
  • Phone: 941-792-0340
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11042775
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: