Provider Demographics
NPI:1972589851
Name:TRUITT, NANCY CAROLYN (FNP)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CAROLYN
Last Name:TRUITT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 S SWAIM STREET EXT
Mailing Address - Street 2:
Mailing Address - City:JONESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28642-9418
Mailing Address - Country:US
Mailing Address - Phone:336-835-6300
Mailing Address - Fax:336-835-4761
Practice Address - Street 1:4000 S SWAIM STREET EXT
Practice Address - Street 2:
Practice Address - City:JONESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28642-9418
Practice Address - Country:US
Practice Address - Phone:336-835-6300
Practice Address - Fax:336-835-4761
Is Sole Proprietor?:No
Enumeration Date:2005-12-21
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCNT200028363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCMT0430328OtherDEA NUMBER