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General NPI Number Information
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NPI Number | 1346277282
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Entity Type | Individual
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Provider Name | NICOLE TUCKER RPAC
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Gender | Female
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Dates
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Enumeration Date | 06/27/2006
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Last Update Date | 05/21/2021
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Provider Practice Location Address
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Address Line | 2655 RIDGEWAY AVE STE 180
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City | ROCHESTER
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State | NY
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Zip | 14626-4296
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Country | US
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Telephone | 585-368-4005
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Fax | 585-225-2685
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Provider Business Mailing Address
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Address Line | 100 KINGS HWY S
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City | ROCHESTER
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State | NY
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Zip | 14617-5504
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Country | US
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Telephone | 585-368-4005
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Fax | 585-225-2685
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 008831
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License Number State | NY
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