Provider Demographics
NPI:1346008976
Name:BRUCE, JACI JEAN (FNP,CRNP)
Entity type:Individual
Prefix:MRS
First Name:JACI
Middle Name:JEAN
Last Name:BRUCE
Suffix:
Gender:F
Credentials:FNP,CRNP
Other - Prefix:MS
Other - First Name:JACI
Other - Middle Name:JEAN
Other - Last Name:BUTEAU
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP,CRNP
Mailing Address - Street 1:8032 C LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:301-631-6733
Practice Address - Street 1:8032 C LIBERTY RD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21701
Practice Address - Country:US
Practice Address - Phone:866-389-2727
Practice Address - Fax:301-631-6733
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR236702363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily