MEDICARE: DARRELL TUCK NP

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	363L00000X	Nurse Practitioner	5020842	NC
2	163W00000X	Registered Nurse	282834	NC
3	363L00000X	Nurse Practitioner	1082583	TX
4	163W00000X	Registered Nurse	1082583	TX

General Provider Information

NPI Number	:	1073243572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARRELL TUCK NP

Provider Business Mailing Address
First Line	:	PO BOX 746724
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-6724
Country	:	US
Telephone Number	:	919-691-2555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1860 W FRANKLIN BLVD
Second Line	:
City	:	GASTONIA
State	:	NC
Zip	:	28052-1468
Country	:	US
Telephone Number	:	704-396-7143
Fax Number	:	980-305-5123

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

Provider Enumeration Date	:	06/16/2022
Last Update Date	:	11/24/2025

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