Provider Demographics
NPI:1639148323
Name:BRUCE, JANET IRENE (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:IRENE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 E RIVER RD
Mailing Address - Street 2:350
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85718-5999
Mailing Address - Country:US
Mailing Address - Phone:520-519-7775
Mailing Address - Fax:520-519-7760
Practice Address - Street 1:2070 W RUDASILL RD
Practice Address - Street 2:STE 130
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-7891
Practice Address - Country:US
Practice Address - Phone:520-797-4468
Practice Address - Fax:520-797-4502
Is Sole Proprietor?:No
Enumeration Date:2006-03-15
Last Update Date:2009-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ071389363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ945488Medicaid
AZ945488Medicaid
AZ945488Medicaid
Z129471Medicare PIN