Provider Demographics
NPI:1508618471
Name:TUCEK, JACQUELINE TINDIRA
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:TINDIRA
Last Name:TUCEK
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 1:435 E SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-4569
Mailing Address - Country:US
Mailing Address - Phone:330-678-3406
Mailing Address - Fax:
Practice Address - Street 1:435 E SCHOOL ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-4569
Practice Address - Country:US
Practice Address - Phone:330-678-3406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN229155163WH0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WH0200XNursing Service ProvidersRegistered NurseHome Health