Healthcare Provider Details

I. General information

NPI: 1679850911
Provider Name (Legal Business Name): NICOLE TUCKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2011
Last Update Date: 11/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7532 W JUDGE PEREZ DR
ARABI LA
70032-1915
US

IV. Provider business mailing address

6110 ORLEANS AVE
NEW ORLEANS LA
70124-3831
US

V. Phone/Fax

Practice location:
  • Phone: 504-682-9550
  • Fax:
Mailing address:
  • Phone: 504-914-6301
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN132749
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: