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General NPI Number Information
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NPI Number | 1588334338
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Entity Type | Organization
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Legal Business Name | TUCKER NURSE STAFFING LLC
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Dates
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Enumeration Date | 09/14/2021
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Last Update Date | 09/14/2021
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Provider Practice Location Address
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Address Line | 1424 SEDONA LN
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-9801
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Country | US
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Telephone | 336-265-2765
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Fax |
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Provider Business Mailing Address
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Address Line | 5711 MCLEANSVILLE RD UNIT 548
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City | MC LEANSVILLE
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State | NC
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Zip | 27301-0257
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Country | US
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Telephone | 336-265-2765
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANGELA CHANEL HART
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Credential |
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Telephone | 336-265-1276
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3140N1450X
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Taxonomy Name | Pediatric Skilled Nursing Facility
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 164W00000X
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Taxonomy Name | Licensed Practical Nurse
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License Number |
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License Number State |
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