Healthcare Provider Details

I. General information

NPI: 1093839623
Provider Name (Legal Business Name): MARGARET TUCK APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 MIKE PADGETT HWY
AUGUSTA GA
30906-3815
US

IV. Provider business mailing address

1330 LAUREL ST
AUGUSTA GA
30904-5708
US

V. Phone/Fax

Practice location:
  • Phone: 706-432-4800
  • Fax:
Mailing address:
  • Phone: 706-738-9750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License NumberRN056671
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: