Provider Demographics
NPI:1184934960
Name:BRUGGER, CAROLINE CLARK (CRNP)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:CLARK
Last Name:BRUGGER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1015 CHESTNUT ST
Mailing Address - Street 2:SUITE 1020
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4316
Mailing Address - Country:US
Mailing Address - Phone:215-955-7785
Mailing Address - Fax:215-955-9362
Practice Address - Street 1:1015 CHESTNUT ST
Practice Address - Street 2:SUITE 1020
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4316
Practice Address - Country:US
Practice Address - Phone:215-955-7785
Practice Address - Fax:215-955-9362
Is Sole Proprietor?:No
Enumeration Date:2010-10-14
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP011551363L00000X
PARN626943363L00000X
PA014280363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA255800Medicare PIN