Provider Demographics
NPI:1881414936
Name:TUCKER, SAMANTHA (BSN, NC-BC)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:BSN, NC-BC
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:
Other - Last Name:DICKINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:104 HOMER AVE
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-1041
Mailing Address - Country:US
Mailing Address - Phone:856-981-2792
Mailing Address - Fax:
Practice Address - Street 1:104 HOMER AVE
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-1041
Practice Address - Country:US
Practice Address - Phone:856-981-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-14
Last Update Date:2024-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ26NR23727800163WG0000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice