Provider Demographics
NPI:1578186417
Name:TUCKER, FRANCHESCA CHEVONNE
Entity Type:Individual
Prefix:
First Name:FRANCHESCA
Middle Name:CHEVONNE
Last Name:TUCKER
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 1:10530 CAMPUS WAY S
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1309
Mailing Address - Country:US
Mailing Address - Phone:240-602-0909
Mailing Address - Fax:
Practice Address - Street 1:1114 YUBA ST
Practice Address - Street 2:STE 220
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-1309
Practice Address - Country:US
Practice Address - Phone:240-816-4358
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-27
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015689363LP0808X
MD192714363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health