Provider Demographics
NPI:1144709320
Name:TUCKER, LORI ROTH (FNP)
Entity type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ROTH
Last Name:TUCKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 2510
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-2510
Mailing Address - Country:US
Mailing Address - Phone:706-922-8251
Mailing Address - Fax:706-922-6695
Practice Address - Street 1:1043 WASHINGTON RD
Practice Address - Street 2:
Practice Address - City:THOMSON
Practice Address - State:GA
Practice Address - Zip Code:30824-7318
Practice Address - Country:US
Practice Address - Phone:706-595-1461
Practice Address - Fax:706-597-9824
Is Sole Proprietor?:No
Enumeration Date:2018-08-09
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GARN170787363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care