Provider Demographics
NPI:1265773790
Name:BOURBEAU, BRIEN M (APRN-C)
Entity type:Individual
Prefix:MR
First Name:BRIEN
Middle Name:M
Last Name:BOURBEAU
Suffix:
Gender:M
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 SUNSET POINT RD STE C
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1443
Mailing Address - Country:US
Mailing Address - Phone:727-797-3155
Mailing Address - Fax:727-797-4301
Practice Address - Street 1:2350 SUNSET POINT RD STE C
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1443
Practice Address - Country:US
Practice Address - Phone:727-797-3155
Practice Address - Fax:727-797-4301
Is Sole Proprietor?:No
Enumeration Date:2013-03-07
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 9235386363LF0000X
FLAPRN9235386363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL106339300Medicaid