Healthcare Provider Details

I. General information

NPI: 1104783034
Provider Name (Legal Business Name): MS. TAMIKA LYNN BRUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/05/2026
Last Update Date: 01/08/2026
Certification Date: 01/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 45TH ST NE APT 528
WASHINGTON DC
20019-4773
US

IV. Provider business mailing address

25227 TRALEE CT
DAMASCUS MD
20872-2723
US

V. Phone/Fax

Practice location:
  • Phone: 202-300-7478
  • Fax:
Mailing address:
  • Phone: 240-418-8865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: