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General NPI Number Information
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NPI Number | 1235331901
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Entity Type | Individual
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Provider Name | JONATHAN NOLEN BRUNER D.O.
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Gender | Male
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Dates
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Enumeration Date | 06/04/2007
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 905 W PLATT ST
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City | TAMPA
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State | FL
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Zip | 33606-2113
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Country | US
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Telephone | 813-485-5780
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Fax |
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Provider Business Mailing Address
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Address Line | 905 W PLATT ST
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City | TAMPA
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State | FL
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Zip | 33606-2113
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Country | US
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Telephone | 813-485-5780
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | 5101016778
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 204D00000X
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Taxonomy Name | Neuromusculoskeletal Medicine & OMM Physician
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License Number | OS13458
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License Number State | FL
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