Healthcare Provider Details

I. General information

NPI: 1659838597
Provider Name (Legal Business Name): MOISES B TUCKLER PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2019
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6463 OREGON JAY RD
WEEKI WACHEE FL
34613-6311
US

IV. Provider business mailing address

6463 OREGON JAY RD
WEEKI WACHEE FL
34613-6311
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-6114
  • Fax: 352-596-0784
Mailing address:
  • Phone: 352-596-6114
  • Fax: 352-596-0784

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9112030
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: