Healthcare Provider Details

I. General information

NPI: 1659285419
Provider Name (Legal Business Name): TAMARA LUZINCOURT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2026
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 N MILITARY TRL
BOCA RATON FL
33431-6344
US

IV. Provider business mailing address

2762 LANTANA RD APT 305
LAKE WORTH FL
33462-2494
US

V. Phone/Fax

Practice location:
  • Phone: 561-421-5111
  • Fax:
Mailing address:
  • Phone: 561-542-5032
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: