Provider Demographics
NPI:1073243572
Name:TUCK, DARRELL (NP)
Entity type:Individual
Prefix:
First Name:DARRELL
Middle Name:
Last Name:TUCK
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8013 WEBB CHAPEL RD
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:NC
Mailing Address - Zip Code:27565-8873
Mailing Address - Country:US
Mailing Address - Phone:919-691-2555
Mailing Address - Fax:
Practice Address - Street 1:1860 W FRANKLIN BLVD
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28205
Practice Address - Country:US
Practice Address - Phone:704-396-7143
Practice Address - Fax:980-305-5123
Is Sole Proprietor?:No
Enumeration Date:2022-06-16
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1082583363L00000X, 163W00000X
NC282834163W00000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse