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General NPI Number Information
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NPI Number | 1164181145
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Entity Type | Organization
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Legal Business Name | TOTAL CARE MEDICINE, L.L.C.
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Dates
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Enumeration Date | 12/17/2021
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Last Update Date | 12/17/2021
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Provider Practice Location Address
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Address Line | 11161 STATE ROAD 70 E UNIT 110-848
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-9407
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Country | US
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Telephone | 703-677-1035
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Fax |
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Provider Business Mailing Address
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Address Line | 11161 STATE ROAD 70 E UNIT 110-848
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City | LAKEWOOD RANCH
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State | FL
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Zip | 34202-9407
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Country | US
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Telephone | 703-677-1035
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. CORY W. LUCAS
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Credential | NP
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Telephone | 703-677-1035
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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