Provider Demographics
NPI:1093319006
Name:BRUNER, TRACEY LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:TRACEY
Middle Name:LYNN
Last Name:BRUNER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:322 COLEMAN ST
Mailing Address - Street 2:
Mailing Address - City:MARLIN
Mailing Address - State:TX
Mailing Address - Zip Code:76661-2358
Mailing Address - Country:US
Mailing Address - Phone:254-803-3561
Mailing Address - Fax:
Practice Address - Street 1:307 LIVE OAK ST
Practice Address - Street 2:
Practice Address - City:MARLIN
Practice Address - State:TX
Practice Address - Zip Code:76661-2365
Practice Address - Country:US
Practice Address - Phone:254-803-3561
Practice Address - Fax:254-883-6066
Is Sole Proprietor?:No
Enumeration Date:2020-11-30
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1015649363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily