MEDICARE: NADIYAH EL-AMIN-LUCAS

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1235785676
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NADIYAH EL-AMIN-LUCAS

Provider Business Mailing Address
First Line	:	2912 E 23RD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-2122
Country	:	US
Telephone Number	:	813-373-5165
Fax Number	:

Provider Business Practice Location Address
First Line	:	2912 E 23RD AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33605-2122
Country	:	US
Telephone Number	:	813-298-3162
Fax Number	:

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

Provider Enumeration Date	:	08/12/2019
Last Update Date	:	08/12/2019

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