Provider Demographics
NPI:1659109932
Name:TUCKER, ALEXSA
Entity type:Individual
Prefix:
First Name:ALEXSA
Middle Name:
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 1:1560 N MAIN ST APT F2
Mailing Address - Street 2:
Mailing Address - City:LAYTON
Mailing Address - State:UT
Mailing Address - Zip Code:84041-2093
Mailing Address - Country:US
Mailing Address - Phone:340-642-1775
Mailing Address - Fax:
Practice Address - Street 1:1560 N MAIN ST APT F2
Practice Address - Street 2:
Practice Address - City:LAYTON
Practice Address - State:UT
Practice Address - Zip Code:84041-2093
Practice Address - Country:US
Practice Address - Phone:340-642-1775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker