Provider Demographics
NPI:1508296393
Name:BRUCE, NELIA (ARNP)
Entity Type:Individual
Prefix:DR
First Name:NELIA
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11531 N 56TH ST
Mailing Address - Street 2:103
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-2238
Mailing Address - Country:US
Mailing Address - Phone:813-999-4963
Mailing Address - Fax:
Practice Address - Street 1:200 S MACDILL AVE
Practice Address - Street 2:#100
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-3532
Practice Address - Country:US
Practice Address - Phone:813-837-2814
Practice Address - Fax:813-839-4336
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9285876363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily