Provider Demographics
NPI:1316179013
Name:TUCKER, CHARLET
Entity Type:Individual
Prefix:
First Name:CHARLET
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16844 127TH AVE
Mailing Address - Street 2:4D
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3150
Mailing Address - Country:US
Mailing Address - Phone:718-527-7792
Mailing Address - Fax:
Practice Address - Street 1:16844 127TH AVE
Practice Address - Street 2:4D
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-3150
Practice Address - Country:US
Practice Address - Phone:718-527-7792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2009-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206288164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse