Provider Demographics
NPI:1821787730
Name:SOBERS, BRUCE ELLIOTT JR (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:ELLIOTT
Last Name:SOBERS
Suffix:JR
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8201 STATE RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-2912
Mailing Address - Country:US
Mailing Address - Phone:215-685-8622
Mailing Address - Fax:215-685-9092
Practice Address - Street 1:8201 STATE RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2912
Practice Address - Country:US
Practice Address - Phone:215-685-8622
Practice Address - Fax:215-685-9092
Is Sole Proprietor?:No
Enumeration Date:2023-05-05
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDRN264698363LF0000X
DCNP500014235363LF0000X
GARN324699363LF0000X
PA646878163W00000X
PASP027875363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse