Provider Demographics
NPI:1437705159
Name:BRUCE, CAITLIN (FNP-BC)
Entity Type:Individual
Prefix:
First Name:CAITLIN
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CAITLIN
Other - Middle Name:
Other - Last Name:VANDIVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:26619 IRON MOUNTAIN ST
Mailing Address - Street 2:
Mailing Address - City:MENIFEE
Mailing Address - State:CA
Mailing Address - Zip Code:92585-3209
Mailing Address - Country:US
Mailing Address - Phone:760-604-1478
Mailing Address - Fax:
Practice Address - Street 1:9850 GENESEE AVE STE 770
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1232
Practice Address - Country:US
Practice Address - Phone:858-677-0777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-18
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95011200363LF0000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology