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General NPI Number Information
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NPI Number | 1679497945
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Entity Type | Individual
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Provider Name | JILLIAN TUCKER
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Gender | Female
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Dates
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Enumeration Date | 08/07/2026
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Last Update Date | 08/07/2026
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Provider Practice Location Address
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Address Line | 250 PALM COAST PKWY NE
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City | PALM COAST
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State | FL
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Zip | 32137-8224
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Country | US
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Telephone | 386-457-4570
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Fax |
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Provider Business Mailing Address
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Address Line | 209 E VINEYARD CT
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City | CAPE MAY
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State | NJ
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Zip | 08204-4277
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Country | US
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Telephone |
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 31659
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License Number State | FL
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