Provider Demographics
NPI:1013590975
Name:TUCKER, CYNTHIA E (RN)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:8980 EXECUTIVE CLUB DR
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:MD
Mailing Address - Zip Code:21875-2366
Mailing Address - Country:US
Mailing Address - Phone:443-614-9072
Mailing Address - Fax:
Practice Address - Street 1:50 W EDMONSTON DR STE 403
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-1200
Practice Address - Country:US
Practice Address - Phone:240-449-3094
Practice Address - Fax:240-489-4415
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR130668163WD0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WD0400XNursing Service ProvidersRegistered NurseDiabetes Educator
Provider Identifiers
StateIdentifier IDID TypeIssuer
20020585OtherBOARD OF DIABETES CARE AND EDUCATION
MDR130668OtherSTATE OF MARYLAND