Individual
CARLY PRUCKNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1624 RIVERSIDE DR, NASHVILLE, TN 37216-4012
(814) 440-1977
Mailing address
1624 RIVERSIDE DR, NASHVILLE, TN 37216-4012
(814) 440-1977
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4369
TN
Other
Enumeration date
12/09/2020
Last updated
03/03/2023
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