Healthcare Provider Details

I. General information

NPI: 1881406635
Provider Name (Legal Business Name): STACY ANN ELIZABETH BRUCE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/20/2025
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25319 INTERSTATE 45 STE 100
SPRING TX
77380-3551
US

IV. Provider business mailing address

25319 INTERSTATE 45 STE 100
SPRING TX
77380-3551
US

V. Phone/Fax

Practice location:
  • Phone: 832-810-0200
  • Fax:
Mailing address:
  • Phone: 832-810-0200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAP70127287
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1178155
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number406576
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: