Provider Demographics
NPI:1922811595
Name:RUNGE, TREVOR (MSN, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:TREVOR
Middle Name:
Last Name:RUNGE
Suffix:
Gender:M
Credentials:MSN, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8203 N 17TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33604-3409
Mailing Address - Country:US
Mailing Address - Phone:727-686-8639
Mailing Address - Fax:
Practice Address - Street 1:1602 OAKFIELD DR STE 205
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-0827
Practice Address - Country:US
Practice Address - Phone:813-655-6367
Practice Address - Fax:813-409-2915
Is Sole Proprietor?:No
Enumeration Date:2025-01-28
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11037344363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health