Provider Demographics
NPI:1154163418
Name:BRUNSWICK, PEYTON RENEE (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:PEYTON
Middle Name:RENEE
Last Name:BRUNSWICK
Suffix:
Gender:
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8207 WATER TOWER DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-6624
Mailing Address - Country:US
Mailing Address - Phone:813-334-5700
Mailing Address - Fax:
Practice Address - Street 1:3502 HENDERSON BLVD STE 312
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4087
Practice Address - Country:US
Practice Address - Phone:813-582-3809
Practice Address - Fax:813-537-8804
Is Sole Proprietor?:No
Enumeration Date:2024-06-08
Last Update Date:2025-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9490082163WP0200X
FL11033836363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0200XNursing Service ProvidersRegistered NursePediatrics