Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 5101016778 | MI |
Y | 204D00000X | Neuromusculoskeletal Medicine (NMM) | OS13458 | FL |
NPI | 1235331901 |
---|---|
Provider Name | Dr. Jonathan Nolen Bruner |
First Address | Tampa, FL 33629 |
Second Address | Tampa, FL 33629-5038 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/06/2007 |
Last Update Date | 21/05/2021 |