MEDICARE: BRUNETTE BASTIEN ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163WP0808X	Psychiatric/Mental Health Registered Nurse	2971515	FL
2	363LF0000X	Family Nurse Practitioner	9271515	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699150953
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRUNETTE BASTIEN ARNP

Provider Business Mailing Address
First Line	:	1425 VISCAYA PKWY STE 101
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3294
Country	:	US
Telephone Number	:	239-293-5829
Fax Number	:	239-236-1200

Provider Business Practice Location Address
First Line	:	1425 VISCAYA PKWY STE 101
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3294
Country	:	US
Telephone Number	:	239-919-4851
Fax Number	:	239-236-1200

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/28/2015
Last Update Date	:	02/01/2023

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Directions to “ BRUNETTE BASTIEN ARNP” Practice Location

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