MEDICARE: TRISHA THOMAS TUCKER AGACNP-BC, FNP-BC

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	363L00000X	Nurse Practitioner	4704304060	MI

General Provider Information

NPI Number	:	1235788035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRISHA THOMAS TUCKER AGACNP-BC, FNP-BC

Provider Business Mailing Address
First Line	:	22619 FOXMOOR DR
Second Line	:
City	:	NOVI
State	:	MI
Zip	:	48374-3729
Country	:	US
Telephone Number	:	248-345-5224
Fax Number	:

Provider Business Practice Location Address
First Line	:	18580 FORT ST
Second Line	:
City	:	RIVERVIEW
State	:	MI
Zip	:	48193-7442
Country	:	US
Telephone Number	:	734-479-8800
Fax Number	:

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

Provider Enumeration Date	:	09/05/2019
Last Update Date	:	09/05/2019

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Directions to “ TRISHA THOMAS TUCKER AGACNP-BC, FNP-BC” Practice Location

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