Provider Demographics
NPI:1124088737
Name:TESSMER-TUCK, JENNIFER ANN (MD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:ANN
Last Name:TESSMER-TUCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5709 LONG BRAKE TRL
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55439-2621
Mailing Address - Country:US
Mailing Address - Phone:651-373-6097
Mailing Address - Fax:
Practice Address - Street 1:5709 LONG BRAKE TRL
Practice Address - Street 2:
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55439-2621
Practice Address - Country:US
Practice Address - Phone:651-373-6097
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-27
Last Update Date:2024-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN48068207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
160002497Medicare ID - Type Unspecified
MN160003130Medicare PIN
I38523Medicare UPIN