Provider Demographics
NPI:1356608574
Name:FRUCCI, JANICE BRADLEY (PA-C)
Entity type:Individual
Prefix:
First Name:JANICE
Middle Name:BRADLEY
Last Name:FRUCCI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3230 PROVIDENCE RD STE 301
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23464-4122
Mailing Address - Country:US
Mailing Address - Phone:757-413-7600
Mailing Address - Fax:757-413-7601
Practice Address - Street 1:3230 PROVIDENCE RD STE 301
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-4122
Practice Address - Country:US
Practice Address - Phone:757-413-7600
Practice Address - Fax:757-413-7601
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2024-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant