Healthcare Provider Details

I. General information

NPI: 1316657752
Provider Name (Legal Business Name): MICHELLE A TUCKER FNP-BC, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 03/25/2026
Certification Date: 03/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 W HIGGINS RD STE 650
HOFFMAN ESTATES IL
60169-7268
US

IV. Provider business mailing address

190 S WOOD DALE RD APT 510
WOOD DALE IL
60191-2235
US

V. Phone/Fax

Practice location:
  • Phone: 815-947-4463
  • Fax:
Mailing address:
  • Phone: 815-557-4637
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number209026284
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number209026284
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209026284
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: