Individual
MS. KELLY C TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
ARNP
Contact information
Practice address
800 N MAITLAND AVE STE 101, MAITLAND, FL 32751-4499
(407) 660-7150
(407) 660-7108
Mailing address
800 N MAITLAND AVE STE 101, MAITLAND, FL 32751-4499
(407) 660-7150
(407) 660-7108
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
APRN9199348
FL
363LF0000X
Family Nurse Practitioner
ARNP9199348
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
015878700
—
FL
Enumeration date
10/12/2015
Last updated
10/13/2020
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