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General NPI Number Information
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NPI Number | 1447696133
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Entity Type | Individual
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Provider Name | MR. DARRIN TUCKETT
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Gender | Male
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Dates
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Enumeration Date | 05/21/2013
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Last Update Date | 01/16/2025
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Provider Practice Location Address
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Address Line | 660 S 200 E STE 250
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City | SLC
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State | UT
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Zip | 84111-3846
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Country | US
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Telephone | 801-359-2256
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Fax |
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Provider Business Mailing Address
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Address Line | 155 E SUNSET VISTA CT
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City | NORTH SALT LAKE
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State | UT
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Zip | 84054-3006
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Country | US
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Telephone |
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Fax |
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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 | 6998855-8900
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 6998855-4405
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License Number State | UT
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