Healthcare Provider Details

I. General information

NPI: 1861657348
Provider Name (Legal Business Name): JEFFREY ALLEN BRUNELLI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/23/2008
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 KINGSLEY AVE STE 401
ORANGE PARK FL
32073-4898
US

IV. Provider business mailing address

330 CORPORATE WAY STE 200
ORANGE PARK FL
32073-6214
US

V. Phone/Fax

Practice location:
  • Phone: 904-661-2394
  • Fax: 904-621-9105
Mailing address:
  • Phone: 904-282-6331
  • Fax: 904-866-4818

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberME122504
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberME122504
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: