Healthcare Provider Details

I. General information

NPI: 1922811595
Provider Name (Legal Business Name): TREVOR RUNGE MSN, APRN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/28/2025
Last Update Date: 05/29/2025
Certification Date: 05/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1602 OAKFIELD DR STE 205
BRANDON FL
33511-0827
US

IV. Provider business mailing address

8203 N 17TH ST
TAMPA FL
33604-3409
US

V. Phone/Fax

Practice location:
  • Phone: 813-655-6367
  • Fax: 813-409-2915
Mailing address:
  • Phone: 727-686-8639
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11037344
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: