MEDICARE: JESSICA LUCKADO CAVENY PA-C

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	363A00000X	Physician Assistant	PA9120022	FL

General Provider Information

NPI Number	:	1871054205
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA LUCKADO CAVENY PA-C

Provider Business Mailing Address
First Line	:	1500 1ST AVE N UNIT 3
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35203-1866
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	14044 SE 48TH AVE
Second Line	:
City	:	STARKE
State	:	FL
Zip	:	32091-6849
Country	:	US
Telephone Number	:	904-263-5422
Fax Number	:

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

Provider Enumeration Date	:	03/28/2019
Last Update Date	:	06/11/2025

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