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: 06/04/2026
Certification Date: 06/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2817 ROCK MERRITT AVE
FORT BRAGG NC
28310-0001
US

IV. Provider business mailing address

127 JONESHAVEN DR
FUQUAY VARINA NC
27526-4333
US

V. Phone/Fax

Practice location:
  • Phone: 910-907-6000
  • 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: