Provider Demographics
NPI:1952819831
Name:TUCKER, DONNA PAM (NP)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:PAM
Last Name:TUCKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:DOS PALOS
Mailing Address - State:CA
Mailing Address - Zip Code:93620-2300
Mailing Address - Country:US
Mailing Address - Phone:678-485-1906
Mailing Address - Fax:
Practice Address - Street 1:1405 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:DOS PALOS
Practice Address - State:CA
Practice Address - Zip Code:93620-2300
Practice Address - Country:US
Practice Address - Phone:678-485-1906
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-13
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN201429363LF0000X
OR10003451363LF0000X
CA95025272363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily