Provider Demographics
NPI:1457595027
Name:TUCKER, RICHARD LAMAR
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:LAMAR
Last Name:TUCKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SW BEAUFORD PL
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32024-5244
Mailing Address - Country:US
Mailing Address - Phone:386-752-3332
Mailing Address - Fax:386-752-3332
Practice Address - Street 1:520 SW BEAUFORD PL
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:FL
Practice Address - Zip Code:32024-5244
Practice Address - Country:US
Practice Address - Phone:386-752-3332
Practice Address - Fax:386-752-3332
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-27
Last Update Date:2009-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9262859163WE0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WE0003XNursing Service ProvidersRegistered NurseEmergency