MEDICARE: MONIQUE TUCKER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	374U00000X	Home Health Aide		FL

General Provider Information

NPI Number	:	1053041046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MONIQUE TUCKER

Provider Business Mailing Address
First Line	:	PO BOX 1252
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33882-1252
Country	:	US
Telephone Number	:	863-325-6740
Fax Number	:

Provider Business Practice Location Address
First Line	:	3054 BUCKEYE POINTE DR
Second Line	:
City	:	WINTER HAVEN
State	:	FL
Zip	:	33881-5916
Country	:	US
Telephone Number	:	863-325-6740
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2022
Last Update Date	:	06/14/2022

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Directions to “ MONIQUE TUCKER ” Practice Location

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