MEDICARE: PATRICK TUCKER CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	AP02881	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1952423568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PATRICK TUCKER CRNA

Provider Business Mailing Address
First Line	:	11414 LAKE SHERWOOD AVE N
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-0406
Country	:	US
Telephone Number	:	225-754-9478
Fax Number	:	225-659-8195

Provider Business Practice Location Address
First Line	:	11414 LAKE SHERWOOD AVE N
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816
Country	:	US
Telephone Number	:	225-754-9478
Fax Number	:	225-659-8195

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	09/28/2018

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