Provider Demographics
NPI:1275048241
Name:TUCKER, CONSTANCE M (CPM, LM)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:M
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CPM, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5441 HANSEL AVE APT J18
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32809-3451
Mailing Address - Country:US
Mailing Address - Phone:813-748-0539
Mailing Address - Fax:
Practice Address - Street 1:1010 ARTHUR AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-2827
Practice Address - Country:US
Practice Address - Phone:407-878-2757
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-12
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI229-49176B00000X
FLMW386176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife