Provider Demographics
NPI:1235788035
Name:TUCKER, TRISHA THOMAS (AGACNP-BC, FNP-BC)
Entity Type:Individual
Prefix:
First Name:TRISHA
Middle Name:THOMAS
Last Name:TUCKER
Suffix:
Gender:F
Credentials:AGACNP-BC, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22619 FOXMOOR DR
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48374-3729
Mailing Address - Country:US
Mailing Address - Phone:248-345-5224
Mailing Address - Fax:
Practice Address - Street 1:18580 FORT ST
Practice Address - Street 2:
Practice Address - City:RIVERVIEW
Practice Address - State:MI
Practice Address - Zip Code:48193-7442
Practice Address - Country:US
Practice Address - Phone:734-479-8800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704304060363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner