Healthcare Provider Details

I. General information

NPI: 1740137249
Provider Name (Legal Business Name): BETHZAIDA BRUNO APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2026
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11616 LAKE UNDERHILL RD STE 205
ORLANDO FL
32825-4466
US

IV. Provider business mailing address

2148 CONTINENTAL ST
SAINT CLOUD FL
34769-7068
US

V. Phone/Fax

Practice location:
  • Phone: 407-601-5308
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License NumberAPRN11046066
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: