Provider Demographics
NPI:1053698704
Name:BRUCE, LYNETTE (RN)
Entity type:Individual
Prefix:MRS
First Name:LYNETTE
Middle Name:
Last Name:BRUCE
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6706 KING RAIL CT
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32810-6707
Mailing Address - Country:US
Mailing Address - Phone:321-460-4559
Mailing Address - Fax:407-523-8162
Practice Address - Street 1:6706 KING RAIL CT
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32810-6707
Practice Address - Country:US
Practice Address - Phone:321-460-4559
Practice Address - Fax:407-523-8162
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN3036472163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health