Doctor Name: | TONYA FISHER PRUITT |
NPI Number: | 1245575539 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | FNP |
License Number: | 5005935 |
Business Practice Address: | 1614 Nc Highway 56 Creedmoor, NC - 275228297 |
Business Phone Number: | 9195827171 |
Business Fax Number: | |
Mailing Address: | 4039 Ridley Field Dr, WAKE FOREST |
State: | NC |
Postal Code: | 275876081 |
Phone Number: | 9195544158 |
Fax Number: | |
NPI Enumeration Date: | 11/28/2012 |
NPI Last Update Date: | 11/28/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363LF0000X |
License Number: | 5005935 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Nurse Practitioner |
Taxonomy Specialization: | Family |
Taxonomy Definition: |