Healthcare Provider Details

I. General information

NPI: 1053344127
Provider Name (Legal Business Name): LUCY C LOVE MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2006
Last Update Date: 04/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 E FLETCHER AVE STE 230
TAMPA FL
33613-4644
US

IV. Provider business mailing address

3000 E FLETCHER AVE STE 230
TAMPA FL
33613-4644
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-2888
  • Fax: 813-971-3787
Mailing address:
  • Phone: 813-971-2888
  • Fax: 813-971-3787

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberME0036743
License Number StateFL

VIII. Authorized Official

Name: DR. LUCY C LOVE
Title or Position: PRESIDENT
Credential: M.D.
Phone: 813-971-2888