Provider Demographics
NPI:1023254398
Name:TUCKER, REBECCA JACKSON (NNP)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:JACKSON
Last Name:TUCKER
Suffix:
Gender:F
Credentials:NNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 CHILDRENS LN
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:NORFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23507-1910
Mailing Address - Country:US
Mailing Address - Phone:757-668-7456
Mailing Address - Fax:757-668-9255
Practice Address - Street 1:601 CHILDRENS LN
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23507-1910
Practice Address - Country:US
Practice Address - Phone:757-668-7456
Practice Address - Fax:757-668-9255
Is Sole Proprietor?:No
Enumeration Date:2008-12-17
Last Update Date:2024-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024166876363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal