Healthcare Provider Details

I. General information

NPI: 1538179270
Provider Name (Legal Business Name): ANDREA L LUSK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 08/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11031 US HIGHWAY 19 SUITE 106
PORT RICHEY FL
34668-2213
US

IV. Provider business mailing address

2560 GULF TO BAY BLVD STE 100
CLEARWATER FL
33765-4421
US

V. Phone/Fax

Practice location:
  • Phone: 727-868-5875
  • Fax:
Mailing address:
  • Phone: 727-799-3772
  • Fax: 727-799-3772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME85673
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: