=====================================================
General NPI Number Information
=====================================================
NPI Number | 1215561238
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | RONALD BRUNK MSN, APRN, FNP-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/28/2020
-----------------------------------------------------
Last Update Date | 11/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 820 N MAIN ST
-----------------------------------------------------
City | CROSSVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 38555-4024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 931-250-5230
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8623 REGENCY PARK BLVD
-----------------------------------------------------
City | PORT RICHEY
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34668-5742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-842-9861
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | APRN11006327
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 36793
-----------------------------------------------------
License Number State | TN
-----------------------------------------------------