Provider Demographics
NPI:1316657752
Name:TUCKER, MICHELLE A (APRN FNP-BC)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:
Credentials:APRN FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 S WOOD DALE RD APT 510
Mailing Address - Street 2:
Mailing Address - City:WOOD DALE
Mailing Address - State:IL
Mailing Address - Zip Code:60191-2235
Mailing Address - Country:US
Mailing Address - Phone:815-557-4637
Mailing Address - Fax:
Practice Address - Street 1:7055 HIGH GROVE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BURR RIDGE
Practice Address - State:IL
Practice Address - Zip Code:60527-7625
Practice Address - Country:US
Practice Address - Phone:630-371-9980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-28
Last Update Date:2025-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209026284363LP2300X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care