Healthcare Provider Details

I. General information

NPI: 1417856147
Provider Name (Legal Business Name): BRUCE EDWARD KIRK MSN, RN, APN, FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2026
Last Update Date: 10/31/2026
Certification Date: 10/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 LEONARD TER
WAYNE NJ
07470-3337
US

IV. Provider business mailing address

65 LEONARD TER
WAYNE NJ
07470-3337
US

V. Phone/Fax

Practice location:
  • Phone: 862-248-7951
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15689400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: