Healthcare Provider Details

I. General information

NPI: 1518977370
Provider Name (Legal Business Name): LUCY A TUCKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/02/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8200 E BELLEVIEW AVE STE 505E
GREENWOOD VILLAGE CO
80111-2978
US

IV. Provider business mailing address

135 S STATE COLLEGE BLVD STE 350
BREA CA
92821-5814
US

V. Phone/Fax

Practice location:
  • Phone: 888-777-1945
  • Fax: 805-413-9099
Mailing address:
  • Phone: 887-777-1945
  • Fax: 805-413-9099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number123580
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: