Provider Demographics
NPI:1588547459
Name:TUCKER-MIGDA, LISA MARIE (FNP-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:TUCKER-MIGDA
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1620 MAYNARD RD
Mailing Address - Street 2:
Mailing Address - City:CHEBOYGAN
Mailing Address - State:MI
Mailing Address - Zip Code:49721-8979
Mailing Address - Country:US
Mailing Address - Phone:231-420-0660
Mailing Address - Fax:231-420-0660
Practice Address - Street 1:1620 MAYNARD RD
Practice Address - Street 2:
Practice Address - City:CHEBOYGAN
Practice Address - State:MI
Practice Address - Zip Code:49721-8979
Practice Address - Country:US
Practice Address - Phone:231-420-0660
Practice Address - Fax:231-420-0660
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIF07250263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily