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Individual
REBECCA SUE TUCKER
Active
Individual
REBECCA SUE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-05389
NC
363AM0700X
Medical Physician Assistant
22559
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20-3555819
TAX ID
NC
Enumeration date
11/15/2012
Last updated
09/28/2023
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