Healthcare Provider Details

I. General information

NPI: 1811567217
Provider Name (Legal Business Name): JACQUELINE ANN LUCAS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

379 6TH AVE W
BRADENTON FL
34205-8820
US

IV. Provider business mailing address

1091 WATERLINE CT
SARASOTA FL
34240-2357
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4150
  • Fax: 941-782-4104
Mailing address:
  • Phone: 586-565-0076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN9508148
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberAPRN11016206
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: