Provider Demographics
NPI:1013053099
Name:BRUNELLO, SANDI MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:SANDI
Middle Name:MARIE
Last Name:BRUNELLO
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 1:333 COMMERCE ST
Mailing Address - Street 2:SUITE 700
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37201-1826
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2455 DUNSTAN RD
Practice Address - Street 2:360
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77005-2537
Practice Address - Country:US
Practice Address - Phone:832-786-4970
Practice Address - Fax:855-722-0157
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX614038363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8N9259OtherBLUE CROSS
TX177224601Medicaid
TX177224601Medicaid
TX8N9259OtherBLUE CROSS