MEDICARE: LINDSEY JO BRUCKLER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	125369	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346871910
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LINDSEY JO BRUCKLER FNP

Provider Business Mailing Address
First Line	:	772 NW GRENADA ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34983-1164
Country	:	US
Telephone Number	:	561-762-7553
Fax Number	:

Provider Business Practice Location Address
First Line	:	1801 NE JENSEN BEACH BLVD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-7233
Country	:	US
Telephone Number	:	772-334-1700
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2020
Last Update Date	:	03/15/2024

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