Healthcare Provider Details

I. General information

NPI: 1134729841
Provider Name (Legal Business Name): LAURA CLARK TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 03/19/2023
Certification Date: 03/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

330 23RD AVE N STE 300
NASHVILLE TN
37203-1690
US

IV. Provider business mailing address

243 FOUNDERS LN
NASHVILLE TN
37209-2287
US

V. Phone/Fax

Practice location:
  • Phone: 615-342-6010
  • Fax:
Mailing address:
  • Phone: 256-520-2124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number198912
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number28443
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: