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General NPI Number Information
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NPI Number | 1417956848
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Entity Type | Individual
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Provider Name | ELIAS LU DTCM, AP, APRN
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Gender | Male
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Dates
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Enumeration Date | 07/18/2005
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Last Update Date | 11/13/2025
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Provider Practice Location Address
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Address Line | 5920 PAN AMERICAN BLVD STE 208B
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City | NORTH PORT
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State | FL
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Zip | 34287-3412
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Country | US
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Telephone | 888-354-2758
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Fax |
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Provider Business Mailing Address
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Address Line | 5753 HIGHWAY 85 N STE 6387
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City | CRESTVIEW
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State | FL
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Zip | 32536-9365
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Country | US
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Telephone |
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | APRN11011629
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AP4251
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License Number State | FL
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