Healthcare Provider Details

I. General information

NPI: 1053698704
Provider Name (Legal Business Name): LYNETTE BRUCE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/09/2011
Last Update Date: 11/09/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6706 KING RAIL CT
ORLANDO FL
32810-6707
US

IV. Provider business mailing address

6706 KING RAIL CT
ORLANDO FL
32810-6707
US

V. Phone/Fax

Practice location:
  • Phone: 321-460-4559
  • Fax: 407-523-8162
Mailing address:
  • Phone: 321-460-4559
  • Fax: 407-523-8162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN3036472
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: