Provider Demographics
NPI:1467824284
Name:TUCKER, JULIE (FNP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48240 70TH AVE
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:MI
Mailing Address - Zip Code:49045-8110
Mailing Address - Country:US
Mailing Address - Phone:269-436-0445
Mailing Address - Fax:
Practice Address - Street 1:1722 SHAFFER ST STE 3
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1633
Practice Address - Country:US
Practice Address - Phone:269-226-8295
Practice Address - Fax:269-226-7791
Is Sole Proprietor?:No
Enumeration Date:2015-10-21
Last Update Date:2021-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704234344363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily