Provider Demographics
NPI:1902044092
Name:TUCKER HOOVER, PATRICIA B (RN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:B
Last Name:TUCKER HOOVER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68600 MATERHORN VW
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92561-3618
Mailing Address - Country:US
Mailing Address - Phone:760-861-3940
Mailing Address - Fax:
Practice Address - Street 1:68600 MATERHORN VW
Practice Address - Street 2:
Practice Address - City:MOUNTAIN CENTER
Practice Address - State:CA
Practice Address - Zip Code:92561-3618
Practice Address - Country:US
Practice Address - Phone:760-861-3940
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-27
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA484517163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health