Provider Demographics
NPI:1932497138
Name:TUCKER, MELISSA SULLIVAN (NP-C)
Entity Type:Individual
Prefix:
First Name:MELISSA
Middle Name:SULLIVAN
Last Name:TUCKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2811 LINKHORNE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24503-3353
Mailing Address - Country:US
Mailing Address - Phone:434-384-1581
Mailing Address - Fax:434-384-5609
Practice Address - Street 1:2811 LINKHORNE DR
Practice Address - Street 2:SUITE A
Practice Address - City:LYNCHBURG
Practice Address - State:VA
Practice Address - Zip Code:24503-3353
Practice Address - Country:US
Practice Address - Phone:434-384-1581
Practice Address - Fax:434-384-5609
Is Sole Proprietor?:No
Enumeration Date:2011-07-21
Last Update Date:2012-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024169502363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily