Basic Information
| Provider Information | |||||||||
| NPI: | 1043520901 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUCKER | ||||||||
| FirstName: | VIVIAN | ||||||||
| MiddleName: | HOPE | ||||||||
| NamePrefix: | MISS | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 800 SUMMIT PLACE | ||||||||
| Address2: | |||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35243 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2057460203 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2151 HIGHLAND AVE SOUTH | ||||||||
| Address2: | SUITE 224 | ||||||||
| City: | BIRMINGHAM | ||||||||
| State: | AL | ||||||||
| PostalCode: | 35205 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2059335744 | ||||||||
| FaxNumber: | 2059336666 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/13/2010 | ||||||||
| LastUpdateDate: | 10/13/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | 1105938 | AL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.