MEDICARE: SOPHIA MARIE BRUCKER FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	35004	TN

General Provider Information

NPI Number	:	1124899158
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SOPHIA MARIE BRUCKER FNP-C

Provider Business Mailing Address
First Line	:	310 25TH AVE N STE 101
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1697
Country	:	US
Telephone Number	:	866-231-0701
Fax Number	:

Provider Business Practice Location Address
First Line	:	310 25TH AVE N STE 101
Second Line	:
City	:	NASHVILLE
State	:	TN
Zip	:	37203-1697
Country	:	US
Telephone Number	:	866-231-0701
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	04/13/2026

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