Healthcare Provider Details

I. General information

NPI: 1790952950
Provider Name (Legal Business Name): ANNE ROMIG TUCKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 09/29/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 13TH ST
GULFPORT MS
39501-2515
US

IV. Provider business mailing address

PO BOX 1810
GULFPORT MS
39502-1810
US

V. Phone/Fax

Practice location:
  • Phone: 228-539-4141
  • Fax: 228-832-3364
Mailing address:
  • Phone: 228-867-5202
  • Fax: 228-867-5007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberR864139
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberR864139
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: