Individual
JASON TUCKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
8961 DANIELS CENTER DR, FORT MYERS, FL 33912-0314
(239) 433-6700
Mailing address
8961 DANIELS CENTER DR, FORT MYERS, FL 33912-0314
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109343400
—
FL
Enumeration date
10/19/2021
Last updated
10/19/2021
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