Healthcare Provider Details

I. General information

NPI: 1548620727
Provider Name (Legal Business Name): DR. JENNIFER LUCAS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/01/2016
Last Update Date: 03/01/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9235 TIBET POINTE CIR
WINDERMERE FL
34786-5632
US

IV. Provider business mailing address

9235 TIBET POINTE CIR
WINDERMERE FL
34786-5632
US

V. Phone/Fax

Practice location:
  • Phone: 407-876-7240
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174M00000X
TaxonomyVeterinarian
License NumberVM10187
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: