Provider Demographics
NPI:1144505314
Name:TUCKER, CARRIE LYNN BRACKBILL (NP-C)
Entity type:Individual
Prefix:MRS
First Name:CARRIE
Middle Name:LYNN BRACKBILL
Last Name:TUCKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4901 CHESAPEAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-2905
Mailing Address - Country:US
Mailing Address - Phone:980-321-3337
Mailing Address - Fax:
Practice Address - Street 1:4601 CHARLOTTE PARK DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28217-1915
Practice Address - Country:US
Practice Address - Phone:980-321-3337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-19
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5005333363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily