Healthcare Provider Details

I. General information

NPI: 1407393663
Provider Name (Legal Business Name): NANCY TUCKER WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2017
Last Update Date: 03/18/2020
Certification Date: 03/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 HAWTHORNE AVE STE K
ATHENS GA
30606-2168
US

IV. Provider business mailing address

1000 HAWTHORNE AVE STE K
ATHENS GA
30606-2168
US

V. Phone/Fax

Practice location:
  • Phone: 706-286-8692
  • Fax:
Mailing address:
  • Phone: 706-286-8692
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN0000022029
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number275887
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code163WX0002X
TaxonomyHigh-Risk Obstetric Registered Nurse
License Number0000194496
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: