Healthcare Provider Details

I. General information

NPI: 1588828958
Provider Name (Legal Business Name): LINDSAY JOY TUCKER RN, NNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 09/23/2022
Certification Date: 09/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

736 CAMBRIDGE ST
BOSTON MA
02135-2907
US

IV. Provider business mailing address

501 COMMERCE DR UNIT1107
BRAINTREE MA
02184-7151
US

V. Phone/Fax

Practice location:
  • Phone: 617-562-7077
  • Fax:
Mailing address:
  • Phone: 774-254-0063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WN0002X
TaxonomyNeonatal Intensive Care Registered Nurse
License Number263317
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LN0005X
TaxonomyCritical Care Neonatal Nurse Practitioner
License NumberRN263317
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: