Healthcare Provider Details

I. General information

NPI: 1376228528
Provider Name (Legal Business Name): DEREK WAYNE BRUNER FNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/15/2023
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 1787
BELLEVIEW FL
34421-1787
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax: 352-273-8612
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11026910
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: