Provider Demographics
NPI:1891091575
Name:TUCKER, REBECCA (ACNP)
Entity Type:Individual
Prefix:MS
First Name:REBECCA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 ELMWOOD AVE
Mailing Address - Street 2:BOX 619-13
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642
Mailing Address - Country:US
Mailing Address - Phone:585-273-2733
Mailing Address - Fax:585-276-0073
Practice Address - Street 1:610 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642
Practice Address - Country:US
Practice Address - Phone:585-273-2733
Practice Address - Fax:585-276-0073
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-28
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY430515363LA2100X
NYF430515-1363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care