Provider Demographics
NPI:1801271713
Name:TUCKER, KEYERIASHON DUGAZON (FNP)
Entity type:Individual
Prefix:
First Name:KEYERIASHON
Middle Name:DUGAZON
Last Name:TUCKER
Suffix:
Gender:
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 EMBARCADERO CTR FL 19
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-3628
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 EMBARCADERO CTR FL 19
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-3628
Practice Address - Country:US
Practice Address - Phone:415-658-6791
Practice Address - Fax:415-252-7176
Is Sole Proprietor?:No
Enumeration Date:2015-07-22
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGAA-NP001450363LF0000X
NC5007796363LF0000X, 363L00000X
AZRNP314416363LF0000X
COC-APN.0101925-C-NP363LF0000X
TX1113029363LF0000X
WAAP61540163363LF0000X
MARN10005374363LF0000X
FLAPRN11020073363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health