Provider Demographics
NPI:1497140917
Name:TUCKER, SARAH R (CNP)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:R
Other - Last Name:RICHARDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10326 N JULIET CT STE A
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61615-1116
Mailing Address - Country:US
Mailing Address - Phone:309-570-1016
Mailing Address - Fax:309-570-1017
Practice Address - Street 1:10326 N JULIET CT STE A
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:IL
Practice Address - Zip Code:61615-1116
Practice Address - Country:US
Practice Address - Phone:309-570-1016
Practice Address - Fax:309-570-1017
Is Sole Proprietor?:No
Enumeration Date:2015-04-01
Last Update Date:2023-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2015009464363LW0102X
IL209014150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health