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General NPI Number Information
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NPI Number | 1346993110
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Entity Type | Individual
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Provider Name | LISA MICHELLE LUCIANO
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Gender | Female
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Dates
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Enumeration Date | 02/01/2022
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2800 S OSCEOLA AVE
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City | ORLANDO
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State | FL
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Zip | 32806-5419
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Country | US
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Telephone | 800-735-1178
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Fax | 772-223-6354
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Provider Business Mailing Address
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Address Line | 2454 METFIELD DR APT 4406
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City | MELBOURNE
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State | FL
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Zip | 32940-5340
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Country | US
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Telephone | 478-808-0639
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA9115669
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License Number State | FL
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