Provider Demographics
NPI:1124761267
Name:RIENTS, TUCKER DOUGLAS (PA-C)
Entity type:Individual
Prefix:
First Name:TUCKER
Middle Name:DOUGLAS
Last Name:RIENTS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:3001 METRO DR STE 460
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:MN
Mailing Address - Zip Code:55425-1548
Mailing Address - Country:US
Mailing Address - Phone:651-999-7022
Mailing Address - Fax:651-999-6970
Practice Address - Street 1:6025 LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55125-1710
Practice Address - Country:US
Practice Address - Phone:651-999-6800
Practice Address - Fax:833-905-0989
Is Sole Proprietor?:No
Enumeration Date:2022-04-17
Last Update Date:2023-12-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MN14708363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant