MEDICARE: KATHERINE BROOKS LUCAS PA-C

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	363AM0700X	Medical Physician Assistant	PA9119275	FL

General Provider Information

NPI Number	:	1235992587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHERINE BROOKS LUCAS PA-C

Provider Business Mailing Address
First Line	:	12416 66TH ST STE A
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-3430
Country	:	US
Telephone Number	:	727-547-4700
Fax Number	:	727-394-8661

Provider Business Practice Location Address
First Line	:	12416 66TH ST STE A
Second Line	:
City	:	LARGO
State	:	FL
Zip	:	33773-3430
Country	:	US
Telephone Number	:	727-547-4700
Fax Number	:	727-394-8661

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

Provider Enumeration Date	:	01/31/2024
Last Update Date	:	04/30/2026

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