Provider Demographics
NPI:1669354403
Name:TUCKER, BRENNA (RD, LDN)
Entity type:Individual
Prefix:
First Name:BRENNA
Middle Name:
Last Name:TUCKER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3510 SCOTTS LN APT 3144
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19129-1691
Mailing Address - Country:US
Mailing Address - Phone:612-840-0349
Mailing Address - Fax:
Practice Address - Street 1:3510 SCOTTS LN
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19129-1566
Practice Address - Country:US
Practice Address - Phone:612-840-0349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-07-23
Last Update Date:2025-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADN009119133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered