Provider Demographics
NPI:1568591121
Name:TUCKER, NANCY A (LMHC, LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LMHC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12144 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEMINOLE
Mailing Address - State:FL
Mailing Address - Zip Code:33772-5630
Mailing Address - Country:US
Mailing Address - Phone:727-504-2999
Mailing Address - Fax:
Practice Address - Street 1:12144 69TH AVE
Practice Address - Street 2:
Practice Address - City:SEMINOLE
Practice Address - State:FL
Practice Address - Zip Code:33772-5630
Practice Address - Country:US
Practice Address - Phone:727-504-2999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW78141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical