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General NPI Number Information
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NPI Number | 1235788035
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Entity Type | Individual
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Provider Name | TRISHA THOMAS TUCKER AGACNP-BC, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/05/2019
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Last Update Date | 09/05/2019
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Provider Practice Location Address
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Address Line | 18580 FORT ST
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City | RIVERVIEW
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State | MI
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Zip | 48193-7442
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Country | US
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Telephone | 734-479-8800
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Fax |
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Provider Business Mailing Address
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Address Line | 22619 FOXMOOR DR
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City | NOVI
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State | MI
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Zip | 48374-3729
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Country | US
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Telephone | 248-345-5224
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 4704304060
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License Number State | MI
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