Healthcare Provider Details

I. General information

NPI: 1053732552
Provider Name (Legal Business Name): TRACY MICHELLE TUCKER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/30/2013
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 CLEVELAND ST
HAMMOND IN
46320-2706
US

IV. Provider business mailing address

1050 CLEVELAND ST
HAMMOND IN
46320-2706
US

V. Phone/Fax

Practice location:
  • Phone: 219-951-8136
  • Fax:
Mailing address:
  • Phone: 219-951-8136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71004771A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number71004771A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: