Provider Demographics
NPI:1558016808
Name:BRUCE, CHAD ALTON (APRN, CPNP-PC)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:ALTON
Last Name:BRUCE
Suffix:
Gender:M
Credentials:APRN, CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:616 WILLIAM DR
Mailing Address - Street 2:
Mailing Address - City:OVILLA
Mailing Address - State:TX
Mailing Address - Zip Code:75154-3612
Mailing Address - Country:US
Mailing Address - Phone:214-718-6857
Mailing Address - Fax:
Practice Address - Street 1:273 E OVILLA RD STE 4
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-2605
Practice Address - Country:US
Practice Address - Phone:972-617-6660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-15
Last Update Date:2022-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1071025363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics