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General NPI Number Information
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NPI Number | 1811567217
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Entity Type | Individual
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Provider Name | JACQUELINE ANN LUCAS APRN
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Gender | Female
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Dates
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Enumeration Date | 06/28/2021
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Last Update Date | 08/07/2025
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Provider Practice Location Address
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Address Line | 379 6TH AVE W
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City | BRADENTON
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State | FL
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Zip | 34205-8820
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Country | US
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Telephone | 941-782-4150
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Fax | 941-782-4104
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Provider Business Mailing Address
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Address Line | 1091 WATERLINE CT
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City | SARASOTA
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State | FL
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Zip | 34240-2357
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Country | US
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Telephone | 586-565-0076
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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 | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | RN9508148
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN11016206
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License Number State | FL
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