Provider Demographics
NPI:1023315751
Name:HONIG, LAURA TUCKER (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:TUCKER
Last Name:HONIG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICHELE
Other - Last Name:TUCKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:800 WALNUT ST FL 16
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-5176
Mailing Address - Country:US
Mailing Address - Phone:215-829-0101
Mailing Address - Fax:215-454-3625
Practice Address - Street 1:800 WALNUT ST FL 16
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-5176
Practice Address - Country:US
Practice Address - Phone:215-829-0101
Practice Address - Fax:215-454-3625
Is Sole Proprietor?:No
Enumeration Date:2011-02-15
Last Update Date:2019-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054683363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical