Provider Demographics
NPI:1841206828
Name:TUCKER, MITZI KAY (ARNP)
Entity Type:Individual
Prefix:
First Name:MITZI
Middle Name:KAY
Last Name:TUCKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MITZI
Other - Middle Name:KAY
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 918025
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32891-8025
Mailing Address - Country:US
Mailing Address - Phone:352-392-7952
Mailing Address - Fax:352-392-7393
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-3003
Practice Address - Country:US
Practice Address - Phone:352-392-7952
Practice Address - Fax:352-392-7393
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2845632363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL305540000Medicaid
FL305540000Medicaid
Q06987Medicare UPIN
FLY027SZMedicare PIN