Provider Demographics
NPI:1447626676
Name:TUCKER, BRITTON LIVINGSTON (PA)
Entity type:Individual
Prefix:
First Name:BRITTON
Middle Name:LIVINGSTON
Last Name:TUCKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2061 HIGHWAY 52
Mailing Address - Street 2:
Mailing Address - City:MONCKS CORNER
Mailing Address - State:SC
Mailing Address - Zip Code:29461-5017
Mailing Address - Country:US
Mailing Address - Phone:843-761-8800
Mailing Address - Fax:843-761-8824
Practice Address - Street 1:2061 HIGHWAY 52
Practice Address - Street 2:
Practice Address - City:MONCKS CORNER
Practice Address - State:SC
Practice Address - Zip Code:29461-5017
Practice Address - Country:US
Practice Address - Phone:843-761-8800
Practice Address - Fax:843-761-8824
Is Sole Proprietor?:No
Enumeration Date:2015-08-11
Last Update Date:2015-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2358363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical