Healthcare Provider Details

I. General information

NPI: 1225454614
Provider Name (Legal Business Name): VALAREE ALEXIS LUCK DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/10/2014
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 E COWBOY WAY STE 103
LABELLE FL
33935-4491
US

IV. Provider business mailing address

825 E COWBOY WAY STE 103
LABELLE FL
33935-4491
US

V. Phone/Fax

Practice location:
  • Phone: 863-342-8437
  • Fax: 863-342-8470
Mailing address:
  • Phone: 863-342-8437
  • Fax: 863-342-8470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS15545
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: