Provider Demographics
NPI:1063824894
Name:TUCKER, JASMINE NICOLE (PA-C)
Entity type:Individual
Prefix:MS
First Name:JASMINE
Middle Name:NICOLE
Last Name:TUCKER
Suffix:
Gender:
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 S. LONG DRIVE
Mailing Address - Street 2:
Mailing Address - City:ROCKINGHAM
Mailing Address - State:NC
Mailing Address - Zip Code:28379-4835
Mailing Address - Country:US
Mailing Address - Phone:910-417-3000
Mailing Address - Fax:910-417-3709
Practice Address - Street 1:925 S. LONG DRIVE
Practice Address - Street 2:
Practice Address - City:ROCKINGHAM
Practice Address - State:NC
Practice Address - Zip Code:28379-4835
Practice Address - Country:US
Practice Address - Phone:910-417-3000
Practice Address - Fax:910-417-3709
Is Sole Proprietor?:No
Enumeration Date:2014-05-28
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-07243363A00000X, 208M00000X
363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical