Provider Demographics
NPI:1083394167
Name:BRUCE, ALEXA DENA (PA - C)
Entity type:Individual
Prefix:
First Name:ALEXA
Middle Name:DENA
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PA - C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4492 BLACKLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4710
Mailing Address - Country:US
Mailing Address - Phone:678-314-8525
Mailing Address - Fax:
Practice Address - Street 1:326 WASHINGTON STREET
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-4710
Practice Address - Country:US
Practice Address - Phone:860-889-8331
Practice Address - Fax:860-823-1501
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-24
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6472363A00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical