Provider Demographics
NPI:1275409211
Name:TUCKER, TERESA MARIE
Entity type:Individual
Prefix:
First Name:TERESA
Middle Name:MARIE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3221 BLUFF VIEW CT APT 202
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22192-1763
Mailing Address - Country:US
Mailing Address - Phone:703-504-7867
Mailing Address - Fax:
Practice Address - Street 1:3221 BLUFF VIEW CT APT 202
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22192-1763
Practice Address - Country:US
Practice Address - Phone:703-504-7867
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-10-16
Last Update Date:2025-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL-109391163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant