Provider Demographics
NPI:1639214711
Name:TUCKER, NANCI D (MD)
Entity Type:Individual
Prefix:DR
First Name:NANCI
Middle Name:D
Last Name:TUCKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1744 ALCATRAZ AVE
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94703-2713
Mailing Address - Country:US
Mailing Address - Phone:510-652-1720
Mailing Address - Fax:510-652-2624
Practice Address - Street 1:595 BUCKINGHAM WAY
Practice Address - Street 2:SUITE 355
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94132-1909
Practice Address - Country:US
Practice Address - Phone:415-566-2727
Practice Address - Fax:415-566-0081
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG74461208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-323-4237OtherFEDERAL TAX ID NUMBER