Individual provider Active NPI

Rebecca Jackson Tucker, NNP

  • Neonatal Nurse Practitioner
  • Norfolk, VA
National Provider Identifier
1023254398
Registry record updated Jun 28, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Neonatal Nurse PractitionerTaxonomy code 363LN0000X
License
0024166876 Issued in VA
Practice address
601 Childrens LN
Fourth Floor
Norfolk, VA 23507-1910
Phone
(757) 668-7456
Fax
(757) 668-9255
NPI assigned
Dec 17, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Neonatal Nurse Practitioner 363LN0000X 0024166876 VA Primary

Addresses

Primary practice location

601 Childrens LN
Fourth Floor
Norfolk, VA 23507-1910

Mailing address

601 Childrens LN
Fourth Floor
Norfolk, VA 23507-1910
Phone (757) 668-7456

Other practice location 1

1840 Amherst St Ste 4-H
Winchester, VA 22601-2808
Phone (405) 365-7897

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA, ND2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20140311000004 VA Practitioner - Nurse Practitioner 8729218839 Reassigns benefits to 2 organizations
I20191126001442 ND Practitioner - Nurse Practitioner 8729218839 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
0024166876VAMDNeonatal Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Specialty Group PLLC CurrentSince Apr 1, 2022 Accepting new patients
Winchester Medical Center CurrentSince Dec 20, 2021 Accepting new patients
Winchester Medical Center CurrentSince Dec 20, 2021 Accepting new patients
Winchester Medical Center Current Accepting new patients
Sanford Medical Center Fargo CurrentSince Sep 3, 2019 Accepting new patients
Sanford Medical Center Fargo CurrentSince Sep 3, 2019 Accepting new patients

Locations

5225 23rd Ave S
Fargo, ND 58104
Phone (701) 234-5933

2400 32nd Ave S
Fargo, ND 58103
Phone (701) 234-8800

1220 Sheyenne St
West Fargo, ND 58078
Phone (701) 234-4445

601 Childrens Ln
Norfolk, VA 23507
Phone (757) 668-7272

601 Childrens Ln
Fl Fourth
Norfolk, VA 23507
Phone (757) 668-7456

1840 Amherst St
Winchester, VA 22601
Phone (540) 536-8700

1840 Amherst St
Ste 4H
Winchester, VA 22601
Phone (405) 365-7897

Organizations & group practices 6

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1229472000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719532800000",
    "number": "1023254398",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "address_2": "FOURTH FLOOR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071910",
            "telephone_number": "757-668-7456",
            "fax_number": "757-668-9255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "601 CHILDRENS LN",
            "address_2": "FOURTH FLOOR",
            "city": "NORFOLK",
            "state": "VA",
            "postal_code": "235071910",
            "telephone_number": "757-668-7456",
            "fax_number": "757-668-9255"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1840 Amherst St Ste 4-H",
            "address_purpose": "LOCATION",
            "city": "Winchester",
            "state": "VA",
            "postal_code": "226012808",
            "country_code": "US",
            "telephone_number": "405-365-7897",
            "fax_number": "540-536-7843",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "TUCKER",
        "first_name": "REBECCA",
        "middle_name": "JACKSON",
        "credential": "NNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-12-17",
        "last_updated": "2024-06-28",
        "certification_date": "2024-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "VA",
            "license": "0024166876",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Norfolk, VA

Sources for this page

Verify at the official NPI Registry.