Provider Demographics
NPI:1275088635
Name:TUCKER, SAMANTHA (APRN-CNS, ACGCNS-BC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:APRN-CNS, ACGCNS-BC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:KUPLICKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4424 E 193RD PL S
Mailing Address - Street 2:
Mailing Address - City:BIXBY
Mailing Address - State:OK
Mailing Address - Zip Code:74008-5819
Mailing Address - Country:US
Mailing Address - Phone:918-812-1200
Mailing Address - Fax:
Practice Address - Street 1:1145 S UTICA AVE STE 701
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4019
Practice Address - Country:US
Practice Address - Phone:918-582-6544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-15
Last Update Date:2025-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0101047163WW0000X, 364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WW0000XNursing Service ProvidersRegistered NurseWound Care