Provider Demographics
NPI:1871046144
Name:TUCKER, CHRISTINE (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTINE
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 OLD GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1115
Mailing Address - Country:US
Mailing Address - Phone:570-479-8797
Mailing Address - Fax:833-228-5591
Practice Address - Street 1:675 JUSTICE WAY ROOM C0049
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46203
Practice Address - Country:US
Practice Address - Phone:877-465-6650
Practice Address - Fax:804-294-2775
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PASP016436363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily