Provider Demographics
NPI:1508574716
Name:TUCKER, LAUREN NICOLE (PA-C)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:NICOLE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAUREN
Other - Middle Name:N
Other - Last Name:HOENDORF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:740-845-6735
Mailing Address - Fax:740-845-6736
Practice Address - Street 1:371 LAFAYETTE ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-9326
Practice Address - Country:US
Practice Address - Phone:740-845-6735
Practice Address - Fax:740-845-6736
Is Sole Proprietor?:No
Enumeration Date:2022-11-08
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.007991RX363A00000X, 363A00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program