Healthcare Provider Details

I. General information

NPI: 1437760915
Provider Name (Legal Business Name): RACHEL LAUREN TUCKER DNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2020
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NW COMMERCE DR
LAKE CITY FL
32055-4709
US

IV. Provider business mailing address

7428 SW 66TH LN
GAINESVILLE FL
32608-0347
US

V. Phone/Fax

Practice location:
  • Phone: 386-719-9000
  • Fax:
Mailing address:
  • Phone: 772-341-6114
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number11008546
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: