Healthcare Provider Details

I. General information

NPI: 1356608574
Provider Name (Legal Business Name): JANICE BRADLEY FRUCCI PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2012
Last Update Date: 11/05/2024
Certification Date: 11/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3230 PROVIDENCE RD STE 301
VIRGINIA BEACH VA
23464-4122
US

IV. Provider business mailing address

3230 PROVIDENCE RD STE 301
VIRGINIA BEACH VA
23464-4122
US

V. Phone/Fax

Practice location:
  • Phone: 757-413-7600
  • Fax: 757-413-7601
Mailing address:
  • Phone: 757-413-7600
  • Fax: 757-413-7601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: