Provider Demographics
NPI:1548607948
Name:BRUCE, ABIGAIL EMILY FAIRLIE (MS, ANP-BC, RN, PHN)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:EMILY FAIRLIE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MS, ANP-BC, RN, PHN
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:FAIRLIE BRUCE
Other - Last Name:CARVALHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:PO BOX 683
Mailing Address - Street 2:
Mailing Address - City:BOLINAS
Mailing Address - State:CA
Mailing Address - Zip Code:94924-0683
Mailing Address - Country:US
Mailing Address - Phone:415-987-6542
Mailing Address - Fax:888-897-6505
Practice Address - Street 1:66 TERRACE AVENUE
Practice Address - Street 2:
Practice Address - City:BOLINAS
Practice Address - State:CA
Practice Address - Zip Code:94924-0683
Practice Address - Country:US
Practice Address - Phone:415-987-6542
Practice Address - Fax:888-897-6505
Is Sole Proprietor?:No
Enumeration Date:2013-05-27
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA802370163WC1500X
CA171400000X
CA23366363LP2300X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No171400000XOther Service ProvidersHealth & Wellness Coach
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care