MEDICARE: MS. TOBI ETIENNE BOWMAN TUCKER RN

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	RN65388	ME

General Provider Information

NPI Number	:	1326491200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TOBI ETIENNE BOWMAN TUCKER RN

Provider Business Mailing Address
First Line	:	12801 N CENTRAL EXPY
Second Line	:	SUITE 1750
City	:	DALLAS
State	:	TX
Zip	:	75243-1716
Country	:	US
Telephone Number	:	877-293-6287
Fax Number	:	888-512-9116

Provider Business Practice Location Address
First Line	:	12801 N CENTRAL EXPY
Second Line	:	SUITE 1750
City	:	DALLAS
State	:	TX
Zip	:	75243-1716
Country	:	US
Telephone Number	:	877-293-6287
Fax Number	:	888-512-9116

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

Provider Enumeration Date	:	07/15/2016
Last Update Date	:	07/15/2016

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