Provider Demographics
NPI:1407533623
Name:BRUNO, HOLLY BETH (FNP-C)
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:BETH
Last Name:BRUNO
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:804 SANTA FE DR STE 100B
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76086-6582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:336 SUGARTREE CIR
Practice Address - Street 2:LIPAN, TX 76462
Practice Address - City:LIPAN
Practice Address - State:TX
Practice Address - Zip Code:76462
Practice Address - Country:US
Practice Address - Phone:817-964-4281
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-29
Last Update Date:2023-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1110273363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner