Provider Demographics
NPI:1902178957
Name:TUCKER, DELORES RAE (RN, APRN, GCNS-BC)
Entity Type:Individual
Prefix:
First Name:DELORES
Middle Name:RAE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RN, APRN, GCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1266 HIGHWAY 515 S
Mailing Address - Street 2:IMS HOSPITALISTS DEE TUCKER
Mailing Address - City:JASPER
Mailing Address - State:GA
Mailing Address - Zip Code:30143-4872
Mailing Address - Country:US
Mailing Address - Phone:404-323-8682
Mailing Address - Fax:
Practice Address - Street 1:1266 HIGHWAY 515 S
Practice Address - Street 2:IMS HOSPITALISTS DEE TUCKER
Practice Address - City:JASPER
Practice Address - State:GA
Practice Address - Zip Code:30143-4872
Practice Address - Country:US
Practice Address - Phone:404-323-8682
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-07
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN068567364SA2200X, 364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology