Provider Demographics
NPI:1720572084
Name:TUCKER, MORGAN NICOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:MORGAN
Middle Name:NICOLE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431 PARK RIDGE LN APT G
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27104-3563
Mailing Address - Country:US
Mailing Address - Phone:704-883-6286
Mailing Address - Fax:
Practice Address - Street 1:6630 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:LEWISVILLE
Practice Address - State:NC
Practice Address - Zip Code:27023-9504
Practice Address - Country:US
Practice Address - Phone:336-945-2080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2018-06-20
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant