Individual
MRS. BEVERLY ANNE TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPN, LMT
Contact information
Practice address
520 SW BEAUFORD PL, LAKE CITY, FL 32024-5244
(386) 752-3332
(386) 752-3332
Mailing address
520 SW BEAUFORD PL, LAKE CITY, FL 32024-5244
(386) 752-3332
(386) 752-3332
Taxonomy
Speciality
Code
Description
License number
State
164W00000X
Licensed Practical Nurse
Primary
PN 5175827
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PN 5175827
STATE LICENSE BOARD
—
Enumeration date
03/27/2009
Last updated
03/27/2009
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