Healthcare Provider Details

I. General information

NPI: 1851238158
Provider Name (Legal Business Name): MCKENNA NICOLE LUKASIEWICZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3919 NEWBERRY RD STE 4
GAINESVILLE FL
32607-4828
US

IV. Provider business mailing address

2930 SW 23RD TER APT 2503
GAINESVILLE FL
32608-2957
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-7984
  • Fax: 352-224-1974
Mailing address:
  • Phone: 813-943-3547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: