Individual
MICHELE RENEE TUCKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
2140 E EDGEWOOD DR, LAKELAND, FL 33803-3604
(863) 669-1212
(863) 666-6089
Mailing address
900 S PINE ISLAND RD STE 800, PLANTATION, FL 33324-3923
(863) 683-4661
(863) 683-2579
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
34008377
OH
208000000X
Pediatrics Physician
Primary
OS 9417
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274953000
—
FL
Enumeration date
07/12/2006
Last updated
10/27/2021
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