Provider Demographics
NPI:1992570204
Name:TUCKER, TRINA A (LVN)
Entity type:Individual
Prefix:
First Name:TRINA
Middle Name:A
Last Name:TUCKER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 HOTEL CIR N STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-2801
Mailing Address - Country:US
Mailing Address - Phone:619-961-2120
Mailing Address - Fax:
Practice Address - Street 1:1660 HOTEL CIR N STE 101
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-2801
Practice Address - Country:US
Practice Address - Phone:619-961-2120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-11-16
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA192077164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse