Provider Demographics
NPI:1992051213
Name:TUCKER, TRACY DE ANN (APN)
Entity type:Individual
Prefix:MRS
First Name:TRACY
Middle Name:DE ANN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:APN
Other - Prefix:MRS
Other - First Name:TRACY
Other - Middle Name:DE ANN
Other - Last Name:SHRAKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:300 CARSON ST
Mailing Address - Street 2:
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-3104
Mailing Address - Country:US
Mailing Address - Phone:870-932-1198
Mailing Address - Fax:870-910-7709
Practice Address - Street 1:300 CARSON ST
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401
Practice Address - Country:US
Practice Address - Phone:870-932-1198
Practice Address - Fax:870-910-7709
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2012-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARS002266364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health