MEDICARE: MS. TASHICA BRUCE FNP

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	277.003537	IL

General Provider Information

NPI Number	:	1275102022
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TASHICA BRUCE FNP

Provider Business Mailing Address
First Line	:	3116 W 100TH ST
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-3507
Country	:	US
Telephone Number	:	231-638-3389
Fax Number	:

Provider Business Practice Location Address
First Line	:	3116 W 100TH ST
Second Line	:
City	:	EVERGREEN PARK
State	:	IL
Zip	:	60805-3507
Country	:	US
Telephone Number	:	312-588-9449
Fax Number	:	630-381-5279

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

Provider Enumeration Date	:	06/24/2021
Last Update Date	:	06/27/2025

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