Provider Demographics
NPI:1346418159
Name:TUCKER, TANYA E (MD)
Entity Type:Individual
Prefix:DR
First Name:TANYA
Middle Name:E
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1530 12TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-4108
Mailing Address - Country:US
Mailing Address - Phone:813-785-4466
Mailing Address - Fax:
Practice Address - Street 1:3515 E FLETCHER AVE
Practice Address - Street 2:MDC 14
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4702
Practice Address - Country:US
Practice Address - Phone:813-785-4466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-14
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME1026972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry