Provider Demographics
NPI:1396295366
Name:BRUCE, JENNIFER (RN, NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:RN, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:713 GRAINGER ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-3261
Mailing Address - Country:US
Mailing Address - Phone:817-336-3968
Mailing Address - Fax:817-336-3917
Practice Address - Street 1:713 GRAINGER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-3261
Practice Address - Country:US
Practice Address - Phone:817-336-3968
Practice Address - Fax:817-336-3917
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX731964163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse