Provider Demographics
NPI:1598516262
Name:TUCKER, AMBER SWAFFORD (RN)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:SWAFFORD
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 2ND AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:TN
Mailing Address - Zip Code:37321-1207
Mailing Address - Country:US
Mailing Address - Phone:423-285-5106
Mailing Address - Fax:423-285-5127
Practice Address - Street 1:385 2ND AVE STE 1
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TN
Practice Address - Zip Code:37321-1207
Practice Address - Country:US
Practice Address - Phone:423-285-5106
Practice Address - Fax:423-285-5127
Is Sole Proprietor?:No
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN206746163WS0121X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0121XNursing Service ProvidersRegistered NursePlastic Surgery