Healthcare Provider Details

I. General information

NPI: 1629379433
Provider Name (Legal Business Name): TUCKAHOE ORTHOPAEDIC ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 MAPLE AVE SUITE 200
RICHMOND VA
23226-2553
US

IV. Provider business mailing address

PO BOX 71690
RICHMOND VA
23255-1690
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-2300
  • Fax: 804-285-8420
Mailing address:
  • Phone: 804-288-2830
  • Fax: 804-288-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0001186619
License Number StateVA

VIII. Authorized Official

Name: MRS. DENISE WILSON NICHOLS
Title or Position: ADMINISTRATOR
Credential:
Phone: 804-288-2830