Healthcare Provider Details

I. General information

NPI: 1629967286
Provider Name (Legal Business Name): ARNELL ULANDA TUCKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2025
Last Update Date: 07/01/2025
Certification Date: 07/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 NORTHSIDE BLVD STE 4600
CUMMING GA
30041-7658
US

IV. Provider business mailing address

1505 NORTHSIDE BLVD STE 4600
CUMMING GA
30041-7658
US

V. Phone/Fax

Practice location:
  • Phone: 770-205-5292
  • Fax: 770-205-5191
Mailing address:
  • Phone: 770-205-5292
  • Fax: 770-205-5191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN186583
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: