Healthcare Provider Details

I. General information

NPI: 1922691856
Provider Name (Legal Business Name): SYDNEY ALIDOR TUCKER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2021
Last Update Date: 03/23/2023
Certification Date: 03/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5955 AIRPORT BLVD
MOBILE AL
36608-3135
US

IV. Provider business mailing address

PO BOX 7987
MOBILE AL
36670-0987
US

V. Phone/Fax

Practice location:
  • Phone: 251-633-0573
  • Fax: 251-410-6079
Mailing address:
  • Phone: 251-633-0573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number1-153758
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number1-153758
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: