Provider Demographics
NPI:1679040240
Name:TUCKER, VIRGINIA MARIE (FNP)
Entity Type:Individual
Prefix:
First Name:VIRGINIA
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3675 HORSHAM TRL
Mailing Address - Street 2:
Mailing Address - City:DEARING
Mailing Address - State:GA
Mailing Address - Zip Code:30808-2361
Mailing Address - Country:US
Mailing Address - Phone:706-564-4807
Mailing Address - Fax:
Practice Address - Street 1:447 N BELAIR RD STE 101
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3091
Practice Address - Country:US
Practice Address - Phone:706-854-2222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN165646363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily