Provider Demographics
NPI:1841020666
Name:TUCKER, CARLA MARIE
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1336 WILBEC RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6351
Mailing Address - Country:US
Mailing Address - Phone:901-495-5338
Mailing Address - Fax:
Practice Address - Street 1:1336 WILBEC RD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-6351
Practice Address - Country:US
Practice Address - Phone:901-495-5338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-06
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program