| Doctor Name: | MRS. THERESA RENEE RUCKER |
| NPI Number: | 1356391882 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | PA |
| License Number: | 2203 |
| Business Practice Address: | 2900 Veterans Way Viera, FL - 329408007 |
| Business Phone Number: | 3216373788 |
| Business Fax Number: | |
| Mailing Address: | 1291 Harbor Town Cir, MELBOURNE |
| State: | FL |
| Postal Code: | 329401912 |
| Phone Number: | 3217570409 |
| Fax Number: | |
| NPI Enumeration Date: | 05/12/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 2203 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |