Healthcare Provider Details

I. General information

NPI: 1992669626
Provider Name (Legal Business Name): CLAIRE WICKS-TUCKER FNP-BC
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 PLAIN ST FL 2
PROVIDENCE RI
02903-4816
US

IV. Provider business mailing address

111 PLAIN ST FL 2
PROVIDENCE RI
02903-4816
US

V. Phone/Fax

Practice location:
  • Phone: 401-444-8361
  • Fax:
Mailing address:
  • Phone: 401-444-8361
  • Fax: 401-444-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN04944
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: