Provider Demographics
NPI:1427839547
Name:TUCKER, BRITTANY S (CRC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:S
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CRC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6115 N DAVIS HWY APT 98A
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32504-6978
Mailing Address - Country:US
Mailing Address - Phone:334-268-9649
Mailing Address - Fax:
Practice Address - Street 1:6115 N DAVIS HWY APT 98A
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-6978
Practice Address - Country:US
Practice Address - Phone:334-268-9649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-13
Last Update Date:2023-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL233307103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation