Individual
TERRY M TUCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP-BC
Contact information
Practice address
2820 NORMANDY DR, PETERSBURG, VA 23805-9372
(804) 504-8764
(804) 504-8845
Mailing address
5342 AUTUMNLEAF DR, NORTH CHESTERFIELD, VA 23234-2806
(804) 504-8764
(804) 504-8845
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
0024067536
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C10279 00X494N13
PROVIDER IDENTIFIER
VA
Enumeration date
04/18/2007
Last updated
06/05/2013
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