Individual
JACLYN TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
6011 HARRY HINES BLVD, SUITE V4.114, DALLAS, TX 75235-5386
(214) 648-1701
Mailing address
6011 HARRY HINES BLVD, SUITE V4.114, DALLAS, TX 75235-5386
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
017266-1
NY
Other
Enumeration date
12/12/2013
Last updated
01/24/2015
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