Provider Demographics
NPI:1881456630
Name:TUGGLE, MARCO D
Entity type:Individual
Prefix:
First Name:MARCO
Middle Name:D
Last Name:TUGGLE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:MARCO
Other - Middle Name:
Other - Last Name:TUGGLE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4456 ELLEN ST
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-8189
Mailing Address - Country:US
Mailing Address - Phone:901-282-9517
Mailing Address - Fax:901-872-4701
Practice Address - Street 1:4456 ELLEN ST
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-8189
Practice Address - Country:US
Practice Address - Phone:901-282-9517
Practice Address - Fax:901-872-4701
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-26
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN84686077343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)