Provider Demographics
NPI:1639521339
Name:TUCKER, CARIE N (CRNP)
Entity Type:Individual
Prefix:
First Name:CARIE
Middle Name:N
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:810 SAINT VINCENTS DR
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35205-1601
Mailing Address - Country:US
Mailing Address - Phone:205-403-2020
Mailing Address - Fax:205-930-2158
Practice Address - Street 1:2910 MORGAN RD
Practice Address - Street 2:
Practice Address - City:BESSEMER
Practice Address - State:AL
Practice Address - Zip Code:35022-6484
Practice Address - Country:US
Practice Address - Phone:205-403-2020
Practice Address - Fax:205-930-2158
Is Sole Proprietor?:No
Enumeration Date:2016-07-06
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-135596363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily