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General NPI Number Information
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NPI Number | 1760429906
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Entity Type | Individual
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Provider Name | THOMAS DAVID LUKACSA PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/31/2006
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Last Update Date | 04/22/2025
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Provider Practice Location Address
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Address Line | 110 HEALTH PARK BLVD
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City | SAINT AUGUSTINE
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State | FL
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Zip | 32086-5776
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Country | US
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Telephone | 904-823-3401
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Fax | 904-829-8649
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Provider Business Mailing Address
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Address Line | PO BOX 100237
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City | GAINESVILLE
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State | FL
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Zip | 32610-0237
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Country | US
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Telephone | 352-392-4541
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Fax | 352-294-8519
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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 | PA9104358
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License Number State | FL
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