Provider Demographics
NPI:1134981103
Name:TUCKER, ANDREA O'DANIEL
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:O'DANIEL
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 GOLF CLUB DR APT 1904
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:AL
Mailing Address - Zip Code:36830-5855
Mailing Address - Country:US
Mailing Address - Phone:256-710-9345
Mailing Address - Fax:
Practice Address - Street 1:4315 GOLF CLUB DR APT 1904
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:AL
Practice Address - Zip Code:36830-5855
Practice Address - Country:US
Practice Address - Phone:256-710-9345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-25
Last Update Date:2024-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program