Provider Demographics
NPI:1063953628
Name:TUCKER, MELISSA GAYLENE (ARNP)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:GAYLENE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:GAYLENE
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP
Mailing Address - Street 1:5494 SE CELESTIAL CIR
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-6651
Mailing Address - Country:US
Mailing Address - Phone:772-267-0114
Mailing Address - Fax:
Practice Address - Street 1:5494 SE CELESTIAL CIR
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34997-6651
Practice Address - Country:US
Practice Address - Phone:772-267-0114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9277885363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily