Individual provider · NPI-1

Tia Bruce, PNP

Nurse Practitioner, Pediatrics · Columbia, MO

NPI number1366996050
StatusActive
Last updated in NPPESAug 10, 2016

Details

NPI
1366996050
Entity type
Individual (NPI-1)
Name
Mrs. Tia Bruce
Credential
PNP
Sex
Female
Sole proprietor
No
Enumeration date
Aug 10, 2016
Last updated
Aug 10, 2016

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363LP0200X Nurse Practitioner, Pediatrics2015044321MOYes

Practice location

303 N Keene St
Suite 404
Columbia, MO 65201-7193

Phone 573-777-7627

Mailing address

816 S Central Ave
Centralia, MO 65240-1810

Phone 573-819-0954

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