Healthcare Provider Details

I. General information

NPI: 1699150953
Provider Name (Legal Business Name): BRUNETTE BASTIEN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2015
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 VISCAYA PKWY STE 101
CAPE CORAL FL
33990-3294
US

IV. Provider business mailing address

1425 VISCAYA PKWY STE 101
CAPE CORAL FL
33990-3294
US

V. Phone/Fax

Practice location:
  • Phone: 239-919-4851
  • Fax: 239-236-1200
Mailing address:
  • Phone: 239-293-5829
  • Fax: 239-236-1200

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95022693
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number9271515
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number2971515
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95022693
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: