Healthcare Provider Details

I. General information

NPI: 1366364374
Provider Name (Legal Business Name): HANNAH NICOLE TUCKNER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 FIELD POINT RD
GREENWICH CT
06830-2801
US

IV. Provider business mailing address

28 CROSS POND RD
POUND RIDGE NY
10576-1302
US

V. Phone/Fax

Practice location:
  • Phone: 203-625-9608
  • Fax:
Mailing address:
  • Phone: 561-284-2964
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number17951
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: