Healthcare Provider Details

I. General information

NPI: 1265773790
Provider Name (Legal Business Name): BRIEN M BOURBEAU APRN-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/04/2022
Certification Date: 03/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2350 SUNSET POINT RD STE C
CLEARWATER FL
33765-1443
US

IV. Provider business mailing address

2350 SUNSET POINT RD STE C
CLEARWATER FL
33765-1443
US

V. Phone/Fax

Practice location:
  • Phone: 727-797-3155
  • Fax: 727-797-4301
Mailing address:
  • Phone: 727-797-3155
  • Fax: 727-797-4301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAPRN9235386
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 9235386
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: