Provider Demographics
NPI:1992274849
Name:TUCKER, BRENDA (FNP-C)
Entity type:Individual
Prefix:
First Name:BRENDA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9715 BURNET RD
Mailing Address - Street 2:BLDG 7, STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758
Mailing Address - Country:US
Mailing Address - Phone:512-505-5500
Mailing Address - Fax:
Practice Address - Street 1:16030 PARK VALLEY DR STE 201
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3647
Practice Address - Country:US
Practice Address - Phone:512-505-5500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-21
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP139533363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily