Provider Demographics
NPI:1407122591
Name:BENJAMIN, TUCKER D (MS, PA-C)
Entity type:Individual
Prefix:
First Name:TUCKER
Middle Name:D
Last Name:BENJAMIN
Suffix:
Gender:F
Credentials:MS, PA-C
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Mailing Address - Street 1:260 E CONGRESS PKWY STE D
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL LAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60014-6235
Mailing Address - Country:US
Mailing Address - Phone:815-759-6363
Mailing Address - Fax:815-759-6360
Practice Address - Street 1:750 E TERRA COTTA AVE STE B
Practice Address - Street 2:
Practice Address - City:CRYSTAL LAKE
Practice Address - State:IL
Practice Address - Zip Code:60014-3621
Practice Address - Country:US
Practice Address - Phone:815-759-6363
Practice Address - Fax:815-759-6360
Is Sole Proprietor?:No
Enumeration Date:2012-03-22
Last Update Date:2024-12-30
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Provider Licenses
StateLicense IDTaxonomies
IL085005769363A00000X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant