Provider Demographics
NPI:1417480203
Name:TUCKER, JESSICA LEA (DO)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:LEA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:MS
Other - First Name:JESSICA
Other - Middle Name:LEA
Other - Last Name:MCCLARREN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7527
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43017-0727
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1638 N MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-1631
Practice Address - Country:US
Practice Address - Phone:740-654-4942
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-07
Last Update Date:2022-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.014301207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine