MEDICARE: CHASE THOMAS PRUITT PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA9116117	FL

General Provider Information

NPI Number	:	1497492615
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHASE THOMAS PRUITT PA-C

Provider Business Mailing Address
First Line	:	3480 WAKE FOREST RD STE 204
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27609-7376
Country	:	US
Telephone Number	:	919-862-5093
Fax Number	:

Provider Business Practice Location Address
First Line	:	13887 NARCOOSSEE RD STE 200
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32832-7221
Country	:	US
Telephone Number	:	844-407-4070
Fax Number	:	407-743-3050

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	04/06/2026

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Directions to “ CHASE THOMAS PRUITT PA-C” Practice Location

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