Provider Demographics
NPI:1851642235
Name:TUCKER, SARA B (ANP)
Entity Type:Individual
Prefix:
First Name:SARA
Middle Name:B
Last Name:TUCKER
Suffix:
Gender:F
Credentials:ANP
Other - Prefix:
Other - First Name:SARA
Other - Middle Name:B
Other - Last Name:BRUCKERHOFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:20 PROGRESS POINT PKWY STE 108
Mailing Address - Street 2:
Mailing Address - City:O FALLON
Mailing Address - State:MO
Mailing Address - Zip Code:63368-2207
Mailing Address - Country:US
Mailing Address - Phone:636-344-2400
Mailing Address - Fax:
Practice Address - Street 1:20 PROGRESS POINT PKWY STE 108
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63368-2207
Practice Address - Country:US
Practice Address - Phone:636-344-2400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2023-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012037552363LA2200X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health