Healthcare Provider Details

I. General information

NPI: 1306377999
Provider Name (Legal Business Name): TAMMY GAIL LUCAS AG-ACNP, ENP, WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2017
Last Update Date: 12/04/2024
Certification Date: 12/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7300 RAEFORD RD
FAYETTEVILLE NC
28304-0807
US

IV. Provider business mailing address

100 IDLEWILDE LN
SANFORD NC
27332-9303
US

V. Phone/Fax

Practice location:
  • Phone: 910-488-2120
  • Fax:
Mailing address:
  • Phone: 907-229-9749
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberLUCA-04B17Z
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5009355
License Number StateNC
# 3
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number1-080479
License Number StateAL
# 4
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License Number5009533
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: