Provider Demographics
NPI:1295710671
Name:TUCKER, GEORGIA C (CRNA)
Entity type:Individual
Prefix:
First Name:GEORGIA
Middle Name:C
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 552437
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33655-0001
Mailing Address - Country:US
Mailing Address - Phone:800-237-6723
Mailing Address - Fax:352-732-6282
Practice Address - Street 1:7050 GALL BLVD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33541-1347
Practice Address - Country:US
Practice Address - Phone:800-237-6723
Practice Address - Fax:352-732-6282
Is Sole Proprietor?:No
Enumeration Date:2005-12-08
Last Update Date:2009-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1068092367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
430028311OtherRAILROAD MEDICARE
FLG0266OtherBCBS
FL034806600Medicaid
FLG0266OtherBCBS
FL034806600Medicaid