Healthcare Provider Details

I. General information

NPI: 1922870021
Provider Name (Legal Business Name): LINDA TUCKER BACK CRNP,FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2023
Last Update Date: 04/30/2026
Certification Date: 04/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 NORTH 24TH STREET
OPELIKA AL
36801-6253
US

IV. Provider business mailing address

111 NORTH 24TH STREET
OPELIKA AL
36801-6253
US

V. Phone/Fax

Practice location:
  • Phone: 334-704-8100
  • Fax: 866-538-3485
Mailing address:
  • Phone: 334-704-8100
  • Fax: 866-538-3485

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1-143078
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: