Provider Demographics
NPI:1760929152
Name:TUCCI, THALIA N (PMHNP-BC)
Entity type:Individual
Prefix:
First Name:THALIA
Middle Name:N
Last Name:TUCCI
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4433 E BROADWAY BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3536
Mailing Address - Country:US
Mailing Address - Phone:877-465-6650
Mailing Address - Fax:
Practice Address - Street 1:4433 E BROADWAY BLVD STE 101
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-3536
Practice Address - Country:US
Practice Address - Phone:877-465-6650
Practice Address - Fax:804-294-2775
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-24
Last Update Date:2025-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2020029685363LP0808X
KS53-77526-082363LP0808X
AZAP9981363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100240930AMedicaid