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General NPI Number Information
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NPI Number | 1912915927
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Entity Type | Individual
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Provider Name | SARAH JANE BRUCE MSPA, PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/04/2006
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Last Update Date | 05/14/2025
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Provider Practice Location Address
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Address Line | 1614 SOUTH BLVD
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City | CHARLOTTE
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State | NC
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Zip | 28203-4726
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Country | US
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Telephone | 704-338-1268
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Fax | 910-779-2025
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Provider Business Mailing Address
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Address Line | 2626 PARK RD APT D
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City | CHARLOTTE
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State | NC
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Zip | 28209-1385
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Country | US
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Telephone | 512-420-7810
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA07226
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 0010-00367
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License Number State | NC
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