Healthcare Provider Details

I. General information

NPI: 1033109137
Provider Name (Legal Business Name): JOSEPHINE LUCAS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 03/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 ENTERPRISE RD E SUITE 910
SAFETY HARBOR FL
34695-5350
US

IV. Provider business mailing address

1154 SEDGEFIELD CT
OLDSMAR FL
34677-4843
US

V. Phone/Fax

Practice location:
  • Phone: 727-514-2859
  • Fax:
Mailing address:
  • Phone: 727-514-2859
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberP02626
License Number StateFL

VIII. Authorized Official

Name: MRS. JOSEPHINE ANNA LUCAS
Title or Position: PRESIDENT
Credential: DPM
Phone: 727-514-2859