Healthcare Provider Details

I. General information

NPI: 1346254943
Provider Name (Legal Business Name): JAMES ROBERT TUCKER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 W MAPLE AVE
GENEVA AL
36340-1642
US

IV. Provider business mailing address

1200 W MAPLE AVE
GENEVA AL
36340-1642
US

V. Phone/Fax

Practice location:
  • Phone: 334-684-3655
  • Fax:
Mailing address:
  • Phone: 334-684-3655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number1-084210
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: