Nikita Deryabin Tucker
Military Health Care Provider, Independent Duty Corpsman in Camp Lejeune, NC. Individual provider (NPI-1).
NPI number1619704152
StatusActive
Last updated in NPPESSep 18, 2024
Details
- NPI
- 1619704152
- Entity type
- Individual (NPI-1)
- Name
- Nikita Deryabin Tucker
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 18, 2024
- Certification date
- Sep 12, 2024
- Last updated
- Sep 18, 2024
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1710I1002X | Military Health Care Provider, Independent Duty Corpsman | 12222246ND | NC | Yes |
Practice location
Psc Box 20183Camp Lejeune, NC 28542-0183
Phone 910-440-7704
Mailing address
Psc Box 20183Camp Lejeune, NC 28542
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