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General NPI Number Information
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NPI Number | 1609701929
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Entity Type | Individual
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Provider Name | TUCKER MENDONCA
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Gender | Male
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Dates
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Enumeration Date | 06/17/2026
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Last Update Date | 06/17/2026
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Provider Practice Location Address
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Address Line | 2085 HENRY TECKLENBURG DR
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City | CHARLESTON
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State | SC
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Zip | 29414-7710
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Country | US
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Telephone | 843-577-6957
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Fax |
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Provider Business Mailing Address
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Address Line | 33 DAVIS ST
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City | SOUTH DARTMOUTH
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State | MA
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Zip | 02748-2311
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Country | US
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Telephone | 207-228-4946
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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 | 163WX0200X
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Taxonomy Name | Oncology Registered Nurse
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License Number | RN10002778
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License Number State | MA
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