MEDICARE: KAREN MICHELLE TUCKER BA

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	104100000X	Social Worker		FL
2	101YM0800X	Mental Health Counselor	MH13794	FL

General Provider Information

NPI Number	:	1700038817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN MICHELLE TUCKER BA

Provider Business Mailing Address
First Line	:	2750 18TH ST S
Second Line	:
City	:	SAINT PETERSBURG
State	:	FL
Zip	:	33712-3818
Country	:	US
Telephone Number	:	727-234-8218
Fax Number	:

Provider Business Practice Location Address
First Line	:	2750 18TH ST S
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33712-3818
Country	:	US
Telephone Number	:	727-234-8218
Fax Number	:

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

Provider Enumeration Date	:	10/21/2008
Last Update Date	:	07/21/2022

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