MEDICARE: LAURA LUCAS

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	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	9366120	FL

General Provider Information

NPI Number	:	1134621873
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LAURA LUCAS

Provider Business Mailing Address
First Line	:	15441 SW 158TH ST
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33187-5407
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3621 SW 107TH AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33165
Country	:	US
Telephone Number	:	786-534-8366
Fax Number	:	786-534-7118

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

Provider Enumeration Date	:	03/07/2018
Last Update Date	:	07/23/2018

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Directions to “ LAURA LUCAS ” Practice Location

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