Provider Demographics
NPI:1053135806
Name:BRUCK, CLINTON (FNP-BC)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:
Last Name:BRUCK
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 CORALBERRY DR
Mailing Address - Street 2:
Mailing Address - City:BEAVER FALLS
Mailing Address - State:PA
Mailing Address - Zip Code:15010-1149
Mailing Address - Country:US
Mailing Address - Phone:724-612-8686
Mailing Address - Fax:
Practice Address - Street 1:134 CORALBERRY DR
Practice Address - Street 2:
Practice Address - City:BEAVER FALLS
Practice Address - State:PA
Practice Address - Zip Code:15010-1149
Practice Address - Country:US
Practice Address - Phone:724-612-8686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031278363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner