Healthcare Provider Details

I. General information

NPI: 1447555123
Provider Name (Legal Business Name): TIFFANY NICOLE TUCKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/11/2011
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

474 W VERMONT AVE
ESCONDIDO CA
92025-6584
US

IV. Provider business mailing address

9465 FARNHAM ST
SAN DIEGO CA
92123-1308
US

V. Phone/Fax

Practice location:
  • Phone: 760-480-2255
  • Fax: 760-888-8339
Mailing address:
  • Phone: 858-573-2602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number100510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: