Provider Demographics
NPI:1265102891
Name:TUCKER, MEGAN ANN (LPN)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:ANN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:181 E CENTER ST
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32348-6410
Mailing Address - Country:US
Mailing Address - Phone:386-247-3141
Mailing Address - Fax:
Practice Address - Street 1:181 E CENTER ST
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32348-6410
Practice Address - Country:US
Practice Address - Phone:386-247-3141
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPN5243693164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse