Provider Demographics
NPI:1679268791
Name:TUCKER, CLAIRESA TONYA (PHLEBOTOMY TECH)
Entity type:Individual
Prefix:
First Name:CLAIRESA
Middle Name:TONYA
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PHLEBOTOMY TECH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13406 CHRISTINE AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44105-7046
Mailing Address - Country:US
Mailing Address - Phone:216-237-7979
Mailing Address - Fax:
Practice Address - Street 1:13406 CHRISTINE AVE
Practice Address - Street 2:
Practice Address - City:GARFIELD HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44105-7046
Practice Address - Country:US
Practice Address - Phone:216-926-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-05
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5023308207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine