Provider Demographics
NPI:1609244805
Name:TUCKER, REGINA JASMINE (PMH,CNS,BC)
Entity Type:Individual
Prefix:MS
First Name:REGINA
Middle Name:JASMINE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PMH,CNS,BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1330 MCCORMICK DR
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5398
Mailing Address - Country:US
Mailing Address - Phone:301-772-1200
Mailing Address - Fax:301-772-8442
Practice Address - Street 1:1330 MCCORMICK DR
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5398
Practice Address - Country:US
Practice Address - Phone:301-772-1200
Practice Address - Fax:301-772-8442
Is Sole Proprietor?:No
Enumeration Date:2015-09-04
Last Update Date:2015-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR150127163WP0807X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0807XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Child & Adolescent