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NPI Code Detail

MEDICARE: TAMARA RUCKER

MEDICARE: TAMARA RUCKER
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
1103K00000XBehavior Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386045425
Entity Type Code : Individual
Provider Name (Legal Business Name) : TAMARA RUCKER
Provider Business Mailing Address
First Line : 730 SW 4TH ST STE 6
Second Line :
City : CAPE CORAL
State : FL
Zip : 33991-1984
Country : US
Telephone Number : 239-910-0712
Fax Number :
Provider Business Practice Location Address
First Line : 730 SW 4TH ST STE 6
Second Line :
City : CAPE CORAL
State : FL
Zip : 33991-1984
Country : US
Telephone Number : 239-910-0712
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/09/2014
Last Update Date : 03/23/2022

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Directions to “ TAMARA RUCKER ” Practice Location

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