Provider Demographics
NPI:1497742977
Name:TUCKER, ELISABETH DUNNING (MD)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:DUNNING
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:D
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4601 SPANISH TRL
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-5039
Mailing Address - Country:US
Mailing Address - Phone:850-432-9536
Mailing Address - Fax:850-433-8940
Practice Address - Street 1:500 CAMPUS DR
Practice Address - Street 2:
Practice Address - City:HANCOCK
Practice Address - State:MI
Practice Address - Zip Code:49930-1452
Practice Address - Country:US
Practice Address - Phone:906-483-1050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301111000207V00000X
FLME52064207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL048638800Medicaid
FL05887XMedicare ID - Type UnspecifiedINDIVIDUAL NUMBER
FLC74728Medicare UPIN