Healthcare Provider Details

I. General information

NPI: 1609701929
Provider Name (Legal Business Name): TUCKER STEVEN MENDONCA FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2085 HENRY TECKLENBURG DR
CHARLESTON SC
29414-7710
US

IV. Provider business mailing address

PO BOX 632509
CINCINNATI OH
45263-2509
US

V. Phone/Fax

Practice location:
  • Phone: 843-577-6957
  • Fax: 843-577-6523
Mailing address:
  • Phone: 888-472-0043
  • Fax: 513-653-4122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number32314
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License NumberRN10002778
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: