Provider Demographics
NPI:1093207458
Name:TUCKER, AMANDA CORINNE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:CORINNE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2331 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6503
Mailing Address - Country:US
Mailing Address - Phone:504-304-3737
Mailing Address - Fax:
Practice Address - Street 1:3601 COLISEUM ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-3606
Practice Address - Country:US
Practice Address - Phone:504-644-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-01
Last Update Date:2018-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator