Provider Demographics
NPI:1952600884
Name:TUCKER, LISA (THEMPPSVC - HHA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:THEMPPSVC - HHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 261304
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33685-1304
Mailing Address - Country:US
Mailing Address - Phone:813-380-2039
Mailing Address - Fax:
Practice Address - Street 1:15003 TURTLE LAKE CT
Practice Address - Street 2:
Practice Address - City:LUTZ
Practice Address - State:FL
Practice Address - Zip Code:33559-7734
Practice Address - Country:US
Practice Address - Phone:813-380-2039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-17
Last Update Date:2012-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1952600884Medicare PIN