Provider Demographics
NPI:1952181828
Name:TUCKER, EMMANUEL TYREE (EMR)
Entity Type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:TYREE
Last Name:TUCKER
Suffix:
Gender:M
Credentials:EMR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 SUMMERLAKE PL
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-3691
Mailing Address - Country:US
Mailing Address - Phone:615-767-9105
Mailing Address - Fax:
Practice Address - Street 1:255 NEW SHACKLE ISLAND RD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2349
Practice Address - Country:US
Practice Address - Phone:615-372-9594
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-29
Last Update Date:2023-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25443207PE0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services