Provider Demographics
NPI:1326786799
Name:RUCKER, TIFFANY LASHAY
Entity Type:Individual
Prefix:MS
First Name:TIFFANY
Middle Name:LASHAY
Last Name:RUCKER
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 1:1981 KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-1968
Mailing Address - Country:US
Mailing Address - Phone:901-409-9740
Mailing Address - Fax:
Practice Address - Street 1:1981 KANSAS ST
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38109-1968
Practice Address - Country:US
Practice Address - Phone:901-409-9740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant