Basic Information
Provider Information
NPI: 1548887581
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BRUNO
FirstName: DEVON
MiddleName:  
NamePrefix: MRS.
NameSuffix:  
Credential: MSN, APRN, FNP-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 515 WEKIVA COMMONS CIR
Address2:  
City: APOPKA
State: FL
PostalCode: 327123645
CountryCode: US
TelephoneNumber: 4074649516
FaxNumber: 4074649519
Practice Location
Address1: 515 WEKIVA COMMONS CIR
Address2:  
City: APOPKA
State: FL
PostalCode: 327123645
CountryCode: US
TelephoneNumber: 4074649516
FaxNumber: 4074649519
Other Information
ProviderEnumerationDate: 06/25/2020
LastUpdateDate: 08/28/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 08/28/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363LF0000XAPRN11000795FLY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily

No ID Information.


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