MEDICARE: TEENA LUKOSE PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363AS0400X	Surgical Physician Assistant
2	363AM0700X	Medical Physician Assistant
3	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1164654968
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TEENA LUKOSE PA-C

Provider Business Mailing Address
First Line	:	6710 RIVERSIDE BLUFFS DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-4101
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6710 RIVERSIDE BLUFFS DR
Second Line	:
City	:	RIVERVIEW
State	:	FL
Zip	:	33578-4101
Country	:	US
Telephone Number	:	908-499-3335
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/13/2009
Last Update Date	:	01/02/2026

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Directions to “ TEENA LUKOSE PA-C” Practice Location

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