MEDICARE: DERRICK TUCKERSON R.N

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	RN731687	CA

General Provider Information

NPI Number	:	1164929915
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DERRICK TUCKERSON R.N

Provider Business Mailing Address
First Line	:	3801 3RD STREET #5J93
Second Line	:	SUITE 200
City	:	SAN FRANSISCO
State	:	CA
Zip	:	94124
Country	:	US
Telephone Number	:	415-401-4448
Fax Number	:

Provider Business Practice Location Address
First Line	:	3801 3RD STREET #5J93
Second Line	:	SUITE 200
City	:	SAN FRANSISCO
State	:	CA
Zip	:	94124
Country	:	US
Telephone Number	:	415-401-4448
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/09/2018

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