Provider Demographics
NPI:1659774693
Name:TUCKER, ELIZABETH TAYLOR (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:TAYLOR
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:SUSANN
Other - Last Name:TAYLOR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP-PC
Mailing Address - Street 1:516 QUINTARD AVE
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36201-5712
Mailing Address - Country:US
Mailing Address - Phone:256-741-9799
Mailing Address - Fax:256-741-9795
Practice Address - Street 1:516 QUINTARD AVE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:36201-5711
Practice Address - Country:US
Practice Address - Phone:256-741-9799
Practice Address - Fax:256-741-9795
Is Sole Proprietor?:No
Enumeration Date:2014-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN050297363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARN209597OtherLIC
AL1-161608OtherALABAMA NURSING LICENSE