Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LN0005X | Nurse Practitioner - Neonatal (Critical Care) | 20415 | TN |
NPI | 1063881068 |
---|---|
Provider Name | Jennifer Tucker |
First Address | Memphis, TN 38117-3645 |
Second Address | Jackson, TN 38301-3923 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2015 |
Last Update Date | 20/09/2015 |