Provider Demographics
NPI:1588334338
Name:TUCKER NURSE STAFFING LLC
Entity type:Organization
Organization Name:TUCKER NURSE STAFFING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:CHANEL
Authorized Official - Last Name:HART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-265-1276
Mailing Address - Street 1:5711 MCLEANSVILLE RD UNIT 548
Mailing Address - Street 2:
Mailing Address - City:MC LEANSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27301-0257
Mailing Address - Country:US
Mailing Address - Phone:336-265-2765
Mailing Address - Fax:
Practice Address - Street 1:1424 SEDONA LN
Practice Address - Street 2:
Practice Address - City:MC LEANSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27301-9801
Practice Address - Country:US
Practice Address - Phone:336-265-2765
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-14
Last Update Date:2021-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Single Specialty
No251J00000XAgenciesNursing CareGroup - Single Specialty
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric