Provider Demographics
NPI:1922144948
Name:TUCKER, LINDA J (NURSE PRACTITIONER)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:J
Last Name:TUCKER
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:161 W PARKHURST PL
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48203-5246
Mailing Address - Country:US
Mailing Address - Phone:313-881-7776
Mailing Address - Fax:
Practice Address - Street 1:21540 W 11 MILE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-3843
Practice Address - Country:US
Practice Address - Phone:248-352-2000
Practice Address - Fax:248-352-8800
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704152752363LW0102X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health