Healthcare Provider Details

I. General information

NPI: 1679403745
Provider Name (Legal Business Name): CHRISTOPHER ANTHONY TUCKER RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2026
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 STONY LANDING RD
MONCKS CORNER SC
29461-2904
US

IV. Provider business mailing address

PO BOX 41554
NORTH CHARLESTON SC
29423-1554
US

V. Phone/Fax

Practice location:
  • Phone: 843-719-5577
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number263463
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code163WE0003X
TaxonomyEmergency Registered Nurse
License Number263463
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: