Provider Demographics
NPI:1578826541
Name:BRUNET, MAURIN
Entity Type:Individual
Prefix:
First Name:MAURIN
Middle Name:
Last Name:BRUNET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22751 YONGE RD
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32736-8861
Mailing Address - Country:US
Mailing Address - Phone:352-735-8011
Mailing Address - Fax:352-735-8166
Practice Address - Street 1:22751 YONGE RD
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32736-8861
Practice Address - Country:US
Practice Address - Phone:352-735-8011
Practice Address - Fax:352-735-8166
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003558000Medicaid
FL003558001Medicaid
FL003558002Medicaid