Healthcare Provider Details

I. General information

NPI: 1720275753
Provider Name (Legal Business Name): JULIA S BRUCE FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2007
Last Update Date: 02/25/2025
Certification Date: 02/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

971 LAKELAND DR STE 557
JACKSON MS
39216-4661
US

IV. Provider business mailing address

PO BOX 23457
JACKSON MS
39225-3457
US

V. Phone/Fax

Practice location:
  • Phone: 601-200-4560
  • Fax:
Mailing address:
  • Phone: 601-200-3631
  • Fax: 601-200-0166

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR853531
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: