Provider Demographics
NPI:1841621042
Name:TUCKER, TAMARA
Entity type:Individual
Prefix:
First Name:TAMARA
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 1:5303 NORTHFIELD RD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BEDFORD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44146-1104
Mailing Address - Country:US
Mailing Address - Phone:216-527-4740
Mailing Address - Fax:
Practice Address - Street 1:5303 NORTHFIELD RD
Practice Address - Street 2:SUITE 115
Practice Address - City:BEDFORD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44146-1104
Practice Address - Country:US
Practice Address - Phone:216-527-4740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN-144271-M-IV164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse