Provider Demographics
NPI:1205818143
Name:TUCK, CYNTHIA BOYD (RN, CPNP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:BOYD
Last Name:TUCK
Suffix:
Gender:F
Credentials:RN, CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 WILSHIRE DR
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701-9648
Mailing Address - Country:US
Mailing Address - Phone:740-453-1506
Mailing Address - Fax:
Practice Address - Street 1:716 ADAIR AVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701-2836
Practice Address - Country:US
Practice Address - Phone:740-454-5239
Practice Address - Fax:740-455-7692
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2011-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN 169704363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196912Medicaid