Healthcare Provider Details

I. General information

NPI: 1922697168
Provider Name (Legal Business Name): HEATHER BRUNK FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2021
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5308 HARROUN RD STE 55
SYLVANIA OH
43560-2174
US

IV. Provider business mailing address

5308 HARROUN RD STE 55
SYLVANIA OH
43560-2174
US

V. Phone/Fax

Practice location:
  • Phone: 419-824-6599
  • Fax: 419-882-3870
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.0027949
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4704347908
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: