Individual
MRS. THERESA RENEE RUCKER
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
2900 VETERANS WAY, VIERA, FL 32940-8007
(321) 637-3788
Mailing address
1291 HARBOR TOWN CIR, MELBOURNE, FL 32940-1912
(321) 757-0409
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
2203
FL
Other
Enumeration date
05/12/2006
Last updated
07/08/2007
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