Provider Demographics
NPI:1639295322
Name:COYNER-BRUNO, PAMELA JOY (RN)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JOY
Last Name:COYNER-BRUNO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5625 OSPREY PARK PLACE
Mailing Address - Street 2:
Mailing Address - City:LITHIA
Mailing Address - State:FL
Mailing Address - Zip Code:33547
Mailing Address - Country:US
Mailing Address - Phone:813-655-2924
Mailing Address - Fax:813-655-2924
Practice Address - Street 1:5625 OSPREY PARK PL
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3815
Practice Address - Country:US
Practice Address - Phone:813-655-2924
Practice Address - Fax:813-655-2924
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9164519163W00000X
IL163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse