=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558626028
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MELISSA A BRUCE F.N.P.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/10/2012
-----------------------------------------------------
Last Update Date | 06/26/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1401 W WHEELER AVE STE A
-----------------------------------------------------
City | ARANSAS PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78336-4530
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-758-1599
-----------------------------------------------------
Fax | 361-758-2227
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1401 W WHEELER AVE SUITE A
-----------------------------------------------------
City | ARANSAS PASS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78336-4522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 361-758-1599
-----------------------------------------------------
Fax | 361-758-2227
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | 500055
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------