Healthcare Provider Details

I. General information

NPI: 1124922786
Provider Name (Legal Business Name): CAROLINE BRUCE LMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2026
Last Update Date: 10/06/2026
Certification Date: 10/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

716 ELM ST
NICEVILLE FL
32578-2018
US

IV. Provider business mailing address

513 31ST ST
NICEVILLE FL
32578-2555
US

V. Phone/Fax

Practice location:
  • Phone: 850-716-4481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA85500
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: