Provider Demographics
NPI:1861278475
Name:TUCKER, RACHAEL (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:RACHAEL
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9101 CAPE COD BLVD
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE VILLAGE
Mailing Address - State:TX
Mailing Address - Zip Code:76227-1733
Mailing Address - Country:US
Mailing Address - Phone:325-829-7020
Mailing Address - Fax:
Practice Address - Street 1:9101 CAPE COD BLVD
Practice Address - Street 2:
Practice Address - City:PROVIDENCE VILLAGE
Practice Address - State:TX
Practice Address - Zip Code:76227-1733
Practice Address - Country:US
Practice Address - Phone:325-829-7020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1115699363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner