Provider Demographics
NPI:1164495297
Name:NAZARIO, BRUNILDA (MD)
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:
Last Name:NAZARIO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1989 W LUMSDEN RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-8821
Mailing Address - Country:US
Mailing Address - Phone:813-653-3111
Mailing Address - Fax:813-653-1384
Practice Address - Street 1:1989 W LUMSDEN RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-8821
Practice Address - Country:US
Practice Address - Phone:813-653-3111
Practice Address - Fax:813-653-1384
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME66254207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL375823100Medicaid
FL25869WMedicare PIN
FL375823100Medicaid