Abigail Emily Fairlie Bruce, MS, ANP-BC, RN, PHN

Primary specialty

Adult Health Nurse PractitionerTaxonomy code 363LA2200X

License

23366 Issued in CA

Practice address

66 Terrace Avenue
Bolinas, CA 94924-0683

Phone

(415) 987-6542

Fax

(888) 897-6505

NPI assigned

May 27, 2013

Last updated

Jun 16, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Other names 1

• Abigail Fairlie Bruce Carvalho Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Master of Science, Nurse Practitioner, Registered Nurse

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1369612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1655337600000",
    "number": "1548607948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 683",
            "city": "BOLINAS",
            "state": "CA",
            "postal_code": "949240683",
            "telephone_number": "415-987-6542",
            "fax_number": "888-897-6505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "66 TERRACE AVENUE",
            "city": "BOLINAS",
            "state": "CA",
            "postal_code": "949240683",
            "telephone_number": "415-987-6542",
            "fax_number": "888-897-6505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BRUCE",
        "first_name": "ABIGAIL",
        "middle_name": "EMILY FAIRLIE",
        "credential": "MS, ANP-BC, RN, PHN",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-05-27",
        "last_updated": "2022-06-16",
        "certification_date": "2021-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "CA",
            "license": "23366",
            "primary": true
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "CA",
            "license": "23366",
            "primary": false
        },
        {
            "code": "163WC1500X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, Community Health",
            "state": "CA",
            "license": "802370",
            "primary": false
        },
        {
            "code": "171400000X",
            "taxonomy_group": "",
            "desc": "Health & Wellness Coach",
            "state": "CA",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ABIGAIL",
            "last_name": "CARVALHO",
            "middle_name": "FAIRLIE BRUCE",
            "credential": "NP",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Media Leones Aranda Medcroft, RN, IBCLC
• Bryan Ivan Barientos, D.D.S
• Patricia Anne Bradford, F.N.P.
• Miguel Ismael Bustamante, DDS
• Coastal Health Alliance (Point Reyes Medical Clinic)
• Liliya Danilyan, LAC
• Ilene Raisefeld Danse, M.D.
• Meadow Evans

• Adult Health Nurse Practitioner in Bolinas, CA
• Providers in Bolinas, CA by specialty
• Adult Health Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.