Healthcare Provider Details

I. General information

NPI: 1821762337
Provider Name (Legal Business Name): DAKOTA TUCKER DNP, APRN, CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/07/2021
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 TOWN PARK BLVD
EVANS GA
30809-3487
US

IV. Provider business mailing address

411 TOWN PARK BLVD
EVANS GA
30809-3487
US

V. Phone/Fax

Practice location:
  • Phone: 706-854-2500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberRN258659
License Number StateGA
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberRN258659
License Number StateGA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier003275375D
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 2
Identifier003275375C
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer
# 3
Identifier003275375A
Identifier TypeMEDICAID
Identifier StateGA
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: