Provider Demographics
NPI:1295098259
Name:TUCKER, CARLOTTA DENISE (STNA)
Entity type:Individual
Prefix:MISS
First Name:CARLOTTA
Middle Name:DENISE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:STNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 N RICHVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44509-2349
Mailing Address - Country:US
Mailing Address - Phone:330-519-9941
Mailing Address - Fax:
Practice Address - Street 1:72 N RICHVIEW AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44509-2349
Practice Address - Country:US
Practice Address - Phone:330-519-9941
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-24
Last Update Date:2012-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH401212790311376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide