Provider Demographics
NPI:1548498421
Name:TUCKER, LLOYD WAYNE (RN)
Entity type:Individual
Prefix:MR
First Name:LLOYD
Middle Name:WAYNE
Last Name:TUCKER
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 41ST STREET OCEAN
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-2373
Mailing Address - Country:US
Mailing Address - Phone:305-434-9000
Mailing Address - Fax:305-434-9040
Practice Address - Street 1:3000 41ST STREET OCEAN
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2373
Practice Address - Country:US
Practice Address - Phone:305-434-9000
Practice Address - Fax:305-434-9040
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-30
Last Update Date:2009-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN2185432163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health