Provider Demographics
NPI:1871161372
Name:TUCKER, QUINNCHEL PREEON
Entity type:Individual
Prefix:
First Name:QUINNCHEL
Middle Name:PREEON
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 1:10615 GRETA LYNN CT
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-7748
Mailing Address - Country:US
Mailing Address - Phone:804-502-9733
Mailing Address - Fax:
Practice Address - Street 1:10615 GRETA LYNN CT
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-7748
Practice Address - Country:US
Practice Address - Phone:804-502-9733
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-12
Last Update Date:2021-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA