Provider Demographics
NPI:1912915927
Name:BRUCE, SARAH JANE (MSPA, PA-C)
Entity type:Individual
Prefix:MS
First Name:SARAH
Middle Name:JANE
Last Name:BRUCE
Suffix:
Gender:F
Credentials:MSPA, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2626 PARK RD APT D
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1385
Mailing Address - Country:US
Mailing Address - Phone:512-420-7810
Mailing Address - Fax:
Practice Address - Street 1:1614 SOUTH BLVD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28203-4726
Practice Address - Country:US
Practice Address - Phone:704-338-1268
Practice Address - Fax:910-779-2025
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07226363A00000X
NC0010-00367363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1912915927Medicaid
NCQ74799Medicare UPIN
NCNCK696C058Medicare PIN