Provider Demographics
NPI:1629810940
Name:TUCKER, ANNA ROUSE (CRNP)
Entity type:Individual
Prefix:MRS
First Name:ANNA
Middle Name:ROUSE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 SUPPLY ROOM RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:AL
Mailing Address - Zip Code:36203-1397
Mailing Address - Country:US
Mailing Address - Phone:256-473-1157
Mailing Address - Fax:
Practice Address - Street 1:641 SNOW ST
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:AL
Practice Address - Zip Code:36203-1207
Practice Address - Country:US
Practice Address - Phone:256-273-4963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-07
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-182790363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty