MEDICARE: DR. LAUREN LUCAS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	PY2701	FL
2	103T00000X	Psychologist	PY2701	FL

General Provider Information

NPI Number	:	1023159415
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAUREN LUCAS PH.D.

Provider Business Mailing Address
First Line	:	3100 UNIVERSITY BLVD S
Second Line	:	#122
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2758
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3100 UNIVERSITY BLVD S
Second Line	:	#122
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-2758
Country	:	US
Telephone Number	:	904-725-2008
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/09/2007
Last Update Date	:	09/11/2025

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1801851266 — LAUREN LUCAS PHD P A
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3100 UNIVERSITY BLVD S , SUITE 122
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1245301316 — MR. DANIEL JESUS SANTIBANEZ MPH, RD, LDN
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1326242520 — JENNA TAYLOR BRADDOCK RD, LDN
Practice Location Address:

3100 UNIVERSITY BLVD S , SUITE 220
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Practice Fax: 904-724-2013

Directions to “ DR. LAUREN LUCAS PH.D.” Practice Location

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