MEDICARE: MS. DOROTHY ANNE TUCKER NP

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	363LF0000X	Family Nurse Practitioner	115291	AZ

General Provider Information

NPI Number	:	1134178270
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOROTHY ANNE TUCKER NP

Provider Business Mailing Address
First Line	:	5055 E BROADWAY BLVD STE A100
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85711-3629
Country	:	US
Telephone Number	:	520-327-0460
Fax Number	:

Provider Business Practice Location Address
First Line	:	8710 N THORNYDALE RD STE 160
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85742-5037
Country	:	US
Telephone Number	:	520-744-2900
Fax Number	:

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

Provider Enumeration Date	:	05/08/2006
Last Update Date	:	12/03/2024

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