Healthcare Provider Details

I. General information

NPI: 1558727636
Provider Name (Legal Business Name): ROBERT JOHN LUCIA DNP, APRN-FPA, FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/06/2016
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 N UNIVERSITY ST
PEORIA IL
61604-1324
US

IV. Provider business mailing address

PO BOX 9727
PEORIA IL
61612-9727
US

V. Phone/Fax

Practice location:
  • Phone: 309-886-9172
  • Fax: 309-509-4045
Mailing address:
  • Phone: 309-886-9172
  • Fax: 309-703-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number277.001430
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: