Healthcare Provider Details

I. General information

NPI: 1396653457
Provider Name (Legal Business Name): JESSICA MARIE TUCKER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4221 WALKER AVE
TOLEDO OH
43612-1855
US

IV. Provider business mailing address

4221 WALKER AVE
TOLEDO OH
43612-1855
US

V. Phone/Fax

Practice location:
  • Phone: 419-671-3600
  • Fax: 419-671-3645
Mailing address:
  • Phone: 419-671-3600
  • Fax: 419-671-3645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number386181
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: