Provider Demographics
NPI:1386326601
Name:MARCELUS, BRUNTINA (NP)
Entity type:Individual
Prefix:
First Name:BRUNTINA
Middle Name:
Last Name:MARCELUS
Suffix:
Gender:
Credentials:NP
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:425 W COLONIAL DR STE 303
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6863
Mailing Address - Country:US
Mailing Address - Phone:833-702-8383
Mailing Address - Fax:689-304-0303
Practice Address - Street 1:6484 FORT CAROLINE RD
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32277-2042
Practice Address - Country:US
Practice Address - Phone:904-744-7300
Practice Address - Fax:904-722-4271
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-04
Last Update Date:2025-04-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLAPRN11025899363LF0000X
KY4015649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily