Provider Demographics
NPI:1912342601
Name:BRUNI, TINA MARIE (NP)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:BRUNI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:MARIE
Other - Last Name:BRUNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:30003 GLADSTONE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-2134
Mailing Address - Country:US
Mailing Address - Phone:248-737-8860
Mailing Address - Fax:
Practice Address - Street 1:30003 GLADSTONE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-2134
Practice Address - Country:US
Practice Address - Phone:248-737-8860
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-05-08
Last Update Date:2021-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704218710363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care