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General NPI Number Information
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NPI Number | 1417137977
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Entity Type | Individual
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Provider Name | STEPHANIE TUCKER M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/13/2007
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Last Update Date | 01/19/2024
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Provider Practice Location Address
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Address Line | 4601 CORBETT DR
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City | FORT COLLINS
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State | CO
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Zip | 80528-9579
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Country | US
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Telephone | 970-207-4857
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Fax | 970-207-4885
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Provider Business Mailing Address
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Address Line | 2695 ROCKY MOUNTAIN AVE STE 150
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City | LOVELAND
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State | CO
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Zip | 80538-9071
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Country | US
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Telephone | 706-242-4219
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Fax | 704-904-1569
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0064887
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 13209A
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License Number State | WY
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Taxonomy #3
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | DR.0072096
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License Number State | CO
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