Provider Demographics
NPI:1386378024
Name:TUCKER, LAURA ELIZABETH (APRN-C)
Entity type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:ELIZABETH
Last Name:TUCKER
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31925 TOLLGATE TRL
Mailing Address - Street 2:
Mailing Address - City:SORRENTO
Mailing Address - State:FL
Mailing Address - Zip Code:32776-9730
Mailing Address - Country:US
Mailing Address - Phone:407-595-1941
Mailing Address - Fax:
Practice Address - Street 1:31925 TOLLGATE TRL
Practice Address - Street 2:
Practice Address - City:SORRENTO
Practice Address - State:FL
Practice Address - Zip Code:32776-9730
Practice Address - Country:US
Practice Address - Phone:407-595-1941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11007753363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily