MEDICARE: ALETHEA HOPE TUCKER 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	363LP2300X	Primary Care Nurse Practitioner	RN285714	GA

General Provider Information

NPI Number	:	1487267415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALETHEA HOPE TUCKER NP

Provider Business Mailing Address
First Line	:	426 EXCHANGE BLVD STE 500
Second Line	:
City	:	BETHLEHEM
State	:	GA
Zip	:	30620-1797
Country	:	US
Telephone Number	:	678-250-0880
Fax Number	:

Provider Business Practice Location Address
First Line	:	3685 BRASELTON HWY STE 100
Second Line	:
City	:	DACULA
State	:	GA
Zip	:	30019-5920
Country	:	US
Telephone Number	:	678-250-0880
Fax Number	:

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

Provider Enumeration Date	:	08/28/2020
Last Update Date	:	09/04/2020

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