Provider Demographics
NPI:1053614024
Name:TUCKER, TERESA MARIA
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:MARIA
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:PO BOX 132
Mailing Address - Street 2:
Mailing Address - City:HORTON
Mailing Address - State:MI
Mailing Address - Zip Code:49246
Mailing Address - Country:US
Mailing Address - Phone:517-563-2378
Mailing Address - Fax:
Practice Address - Street 1:6740 FOLKS RD
Practice Address - Street 2:
Practice Address - City:HORTON
Practice Address - State:MI
Practice Address - Zip Code:49246
Practice Address - Country:US
Practice Address - Phone:517-563-2378
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-14
Last Update Date:2010-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care