Healthcare Provider Details

I. General information

NPI: 1295710671
Provider Name (Legal Business Name): GEORGIA C TUCKER CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2005
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 GALL BLVD
ZEPHYRHILLS FL
33541-1347
US

IV. Provider business mailing address

PO BOX 552437
TAMPA FL
33655-0001
US

V. Phone/Fax

Practice location:
  • Phone: 800-237-6723
  • Fax: 352-732-6282
Mailing address:
  • Phone: 800-237-6723
  • Fax: 352-732-6282

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberARNP1068092
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: