Healthcare Provider Details

I. General information

NPI: 1346008976
Provider Name (Legal Business Name): JACI JEAN BRUCE FNP,CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JACI JEAN BUTEAU FNP,CRNP

II. Dates (important events)

Enumeration Date: 03/08/2024
Last Update Date: 11/26/2024
Certification Date: 03/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8032 C LIBERTY RD
FREDERICK MD
21701
US

IV. Provider business mailing address

8032 C LIBERTY RD
FREDERICK MD
21701
US

V. Phone/Fax

Practice location:
  • Phone: 866-389-2727
  • Fax: 301-631-6733
Mailing address:
  • Phone: 866-389-2727
  • Fax: 301-631-6733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR236702
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: