Healthcare Provider Details

I. General information

NPI: 1467522490
Provider Name (Legal Business Name): LISA A TUCKER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2006
Last Update Date: 03/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 PACIFIC AVE STE 500
EVERETT WA
98201-4189
US

IV. Provider business mailing address

PO BOX 5127
EVERETT WA
98206-5127
US

V. Phone/Fax

Practice location:
  • Phone: 425-339-5430
  • Fax:
Mailing address:
  • Phone: 425-258-3903
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberAP30004191
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: