Healthcare Provider Details

I. General information

NPI: 1033815089
Provider Name (Legal Business Name): ALEXCEA A DEBRUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2023
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2495 RAY RD
SPRING LAKE NC
28390-7531
US

IV. Provider business mailing address

127 JONESHAVEN DR
FUQUAY VARINA NC
27526-4333
US

V. Phone/Fax

Practice location:
  • Phone: 910-551-0511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberLAT-5839
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: