Provider Demographics
NPI:1548718919
Name:TUCKER, MOLLY ANNE (CRNP)
Entity type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:TUCKER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANNE
Other - Last Name:REXILIUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:409 S 2ND ST STE 2F
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17104-1612
Mailing Address - Country:US
Mailing Address - Phone:717-231-8929
Mailing Address - Fax:717-231-8588
Practice Address - Street 1:366 ALEXANDER SPRING RD
Practice Address - Street 2:SUITE 4
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17015
Practice Address - Country:US
Practice Address - Phone:717-243-9021
Practice Address - Fax:717-243-9718
Is Sole Proprietor?:No
Enumeration Date:2016-09-14
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP016393363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner