Provider Demographics
NPI:1447266523
Name:BRUCE, SHARON (PAC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 490
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:VA
Mailing Address - Zip Code:24465-0490
Mailing Address - Country:US
Mailing Address - Phone:540-468-6400
Mailing Address - Fax:540-468-3301
Practice Address - Street 1:120 JACKSON RIVER RD
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:VA
Practice Address - Zip Code:24465-2416
Practice Address - Country:US
Practice Address - Phone:540-468-6400
Practice Address - Fax:540-468-3301
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102165363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
R60490Medicare UPIN