Healthcare Provider Details

I. General information

NPI: 1598764250
Provider Name (Legal Business Name): EMILY CATHERINE HOPE TUCKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 09/12/2024
Certification Date: 09/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

937 RIVERWALK PKWY STE 101
ROCK HILL SC
29730-0179
US

IV. Provider business mailing address

225 BALDWIN AVE
CHARLOTTE NC
28204-3109
US

V. Phone/Fax

Practice location:
  • Phone: 803-325-1618
  • Fax: 803-980-8418
Mailing address:
  • Phone: 704-376-1605
  • Fax: 704-335-8448

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2102
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number201763
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: