Provider Demographics
NPI:1760277636
Name:TUCKER-VANSANDT, NIKITA
Entity type:Individual
Prefix:MRS
First Name:NIKITA
Middle Name:
Last Name:TUCKER-VANSANDT
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:NIKITA
Other - Middle Name:LECORA
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4171 LOMAC ST STE F
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106-2945
Mailing Address - Country:US
Mailing Address - Phone:334-246-1296
Mailing Address - Fax:
Practice Address - Street 1:4171 LOMAC ST STE F
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106-2945
Practice Address - Country:US
Practice Address - Phone:334-246-1296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-04-11
Last Update Date:2025-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL20250212253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care