Nicole Michele Bruno, DO
Individual provider Active NPI Pediatrics Physician · Estero, FL
NPI 1801068333 · NPPES record last updated Nov 30, 2015
Key facts
- NPI
- 1801068333
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pediatrics Physician 208000000X
- License
- OS13547 (FL)
- Practice address
- 9911 Corkscrew Rd
Suite 101
Estero, FL 33928-3323 - Phone
- (239) 768-2111
- Fax
- (239) 482-4404
- NPI assigned
- Mar 25, 2008
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| OS13547 | FL | MD | Pediatrics Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Island Coast Pediatrics | Pediatrics | Past | Accepting new patients |
Interoperability endpoints
- nbruno@icpeds.opdirect.net
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 258683 | NY | |
| Pediatrics Physician | 208000000X | OS13547 | FL | Yes |
Addresses
Primary practice location
9911 Corkscrew Rd
Suite 101
Estero, FL 33928-3323
Mailing address
20617 Eastgolden Elm Dr
Estero, FL 33928-3471
Phone (607) 547-3074
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 015615700 | Medicaid | FL |
Other names
- Nicole Michele Charnetzky
Other providers in Estero, FL
- Bruce Michael Bridewell
- Stephen Danyael Bridges
- Rochelle Lynn Brindley
- Giselle Brito Mantilla
- Lindsay S Brown
- Rachel Lynn Bryant
- Meira Charlee Buck
- Karen Bucur
- Wendy Uyen Bui
- Megan Burke
All providers in Estero, FL · Pediatrics Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 30, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.