Provider Demographics
NPI:1720003023
Name:TUCKER, N H III (MD,PA)
Entity Type:Individual
Prefix:DR
First Name:N
Middle Name:H
Last Name:TUCKER
Suffix:III
Gender:M
Credentials:MD,PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2149 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32204-4418
Mailing Address - Country:US
Mailing Address - Phone:904-384-2525
Mailing Address - Fax:904-389-4135
Practice Address - Street 1:2149 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4418
Practice Address - Country:US
Practice Address - Phone:904-384-2525
Practice Address - Fax:904-389-4135
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2013-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0022569207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD67144Medicare UPIN
FL16966Medicare ID - Type Unspecified