Provider Demographics
NPI:1659094050
Name:BRUNOT, LEONIDE (APRN)
Entity type:Individual
Prefix:
First Name:LEONIDE
Middle Name:
Last Name:BRUNOT
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3905 DUE WEST RD NW
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-1019
Mailing Address - Country:US
Mailing Address - Phone:678-290-5740
Mailing Address - Fax:
Practice Address - Street 1:3905 DUE WEST RD NW
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-1019
Practice Address - Country:US
Practice Address - Phone:678-290-5740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020252363LF0000X
GAGAANP003179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily