Provider Demographics
NPI:1205037082
Name:TUCCI, JILL ADRIAN (LAC)
Entity Type:Individual
Prefix:MS
First Name:JILL
Middle Name:ADRIAN
Last Name:TUCCI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3113 N PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:COLO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-5553
Mailing Address - Country:US
Mailing Address - Phone:719-634-8706
Mailing Address - Fax:
Practice Address - Street 1:2924 BEACON ST
Practice Address - Street 2:SUITE A
Practice Address - City:COLO SPGS
Practice Address - State:CO
Practice Address - Zip Code:80907-5553
Practice Address - Country:US
Practice Address - Phone:719-634-3010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO143171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist