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General NPI Number Information
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NPI Number | 1336204833
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Entity Type | Individual
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Provider Name | JACQUELYN NMI TUCKER FNP-C
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Gender | Female
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 02/17/2009
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Provider Practice Location Address
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Address Line | 500 W PLUMMER ST
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City | EASTLAND
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State | TX
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Zip | 76448-2629
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Country | US
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Telephone | 254-629-3393
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Fax | 254-629-2851
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Provider Business Mailing Address
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Address Line | 418 E PERSHING ST
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City | EASTLAND
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State | TX
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Zip | 76448-3547
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Country | US
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Telephone | 254-629-1956
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Fax | 254-629-2851
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 229661
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License Number State | TX
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