Provider Demographics
NPI:1942064795
Name:TUCKER, JORDAN GRACE (LM, CPM)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:GRACE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 43RD AVE SW
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32968-2382
Mailing Address - Country:US
Mailing Address - Phone:772-766-5683
Mailing Address - Fax:772-539-8369
Practice Address - Street 1:126 43RD AVE SW
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32968-2382
Practice Address - Country:US
Practice Address - Phone:772-766-5683
Practice Address - Fax:772-539-8369
Is Sole Proprietor?:No
Enumeration Date:2024-02-12
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW449176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife