Provider Demographics
NPI:1598060592
Name:BRUCE, CANDICE L (NP)
Entity Type:Individual
Prefix:
First Name:CANDICE
Middle Name:L
Last Name:BRUCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1612 CALLAWAY DR
Mailing Address - Street 2:
Mailing Address - City:ALVIN
Mailing Address - State:TX
Mailing Address - Zip Code:77511-3743
Mailing Address - Country:US
Mailing Address - Phone:281-824-1480
Mailing Address - Fax:281-220-6407
Practice Address - Street 1:1108 E MULBERRY ST STE A
Practice Address - Street 2:
Practice Address - City:ANGLETON
Practice Address - State:TX
Practice Address - Zip Code:77515-3955
Practice Address - Country:US
Practice Address - Phone:409-266-1888
Practice Address - Fax:979-849-1094
Is Sole Proprietor?:No
Enumeration Date:2011-01-21
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX1096125363LF0000X, 363LW0102X
TN16435363LF0000X, 363LW0102X
VA0024172239363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL522000015Medicare PIN
IL522000015Medicare PIN