Healthcare Provider Details

I. General information

NPI: 1023923133
Provider Name (Legal Business Name): MARINA BRUCKNER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6834 PARKSIDE DR
NEW PORT RICHEY FL
34653-2914
US

IV. Provider business mailing address

6834 PARKSIDE DR
NEW PORT RICHEY FL
34653-2914
US

V. Phone/Fax

Practice location:
  • Phone: 727-267-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number11048967
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: