Provider Demographics
NPI:1134479942
Name:BRUNORI, ANTHONY JOHN (FNP)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:JOHN
Last Name:BRUNORI
Suffix:
Gender:M
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:PO BOX 21351
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43221-0351
Mailing Address - Country:US
Mailing Address - Phone:614-776-4379
Mailing Address - Fax:614-569-2257
Practice Address - Street 1:3924 MOUNTVIEW RD
Practice Address - Street 2:
Practice Address - City:UPPER ARLINGTON
Practice Address - State:OH
Practice Address - Zip Code:43220-4806
Practice Address - Country:US
Practice Address - Phone:614-776-4379
Practice Address - Fax:614-569-2257
Is Sole Proprietor?:No
Enumeration Date:2012-09-19
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13680-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0073307Medicaid
OH0073307Medicaid