Provider Demographics
NPI:1558866830
Name:TUCKER-BLUNT, BRIANA DENISE
Entity Type:Individual
Prefix:MS
First Name:BRIANA
Middle Name:DENISE
Last Name:TUCKER-BLUNT
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 1:1622 TUCKER RD
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:VA
Mailing Address - Zip Code:24557-2067
Mailing Address - Country:US
Mailing Address - Phone:434-258-6127
Mailing Address - Fax:
Practice Address - Street 1:1622 TUCKER RD
Practice Address - Street 2:
Practice Address - City:GRETNA
Practice Address - State:VA
Practice Address - Zip Code:24557-2067
Practice Address - Country:US
Practice Address - Phone:434-258-6127
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-28
Last Update Date:2018-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAA60430549347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle