Individual
DR. JANNA MARIE TUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M. D.
Contact information
Practice address
1651 GALISTEO ST STE 8, SANTA FE, NM 87505-4752
(505) 820-9870
(505) 983-1265
Mailing address
DEPT. 453 PO BOX 1000, MEMPHIS, TN 38148-0001
(828) 575-2625
(828) 350-2174
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
108098
MO
207K00000X
Allergy & Immunology Physician
Primary
MD2017-0858
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
55771718
—
NM
01
—
637008AU6T
MEDICARE PTAN
NM
Enumeration date
10/27/2005
Last updated
04/27/2022
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