Provider Demographics
NPI:1114273463
Name:TSUKANOV, JESSICA M (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:M
Last Name:TSUKANOV
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:PO BOX 91734
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23291-1734
Mailing Address - Country:US
Mailing Address - Phone:804-358-6100
Mailing Address - Fax:804-342-7619
Practice Address - Street 1:1250 E MARSHALL ST
Practice Address - Street 2:DEPT. OF FAMILY MEDICINE AND POPULATION HEALTH
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298-5051
Practice Address - Country:US
Practice Address - Phone:804-828-5883
Practice Address - Fax:804-828-5399
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2015-09-22
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Provider Licenses
StateLicense IDTaxonomies
VA0102204221207Q00000X, 207QH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207QH0002XAllopathic & Osteopathic PhysiciansFamily MedicineHospice and Palliative Medicine