MEDICARE: TIMOTHY LUCEY DO PLLC

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	2084N0400X	Neurology Physician	OS10412	FL

General Provider Information

NPI Number	:	1477719656
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TIMOTHY LUCEY DO PLLC

Provider Business Mailing Address
First Line	:	PO BOX 15718
Second Line	:
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32035-3112
Country	:	US
Telephone Number	:	904-277-3311
Fax Number	:	904-277-3343

Provider Business Practice Location Address
First Line	:	1865 LIME ST
Second Line	:	SUITE 103
City	:	FERNANDINA BEACH
State	:	FL
Zip	:	32034-4779
Country	:	US
Telephone Number	:	904-277-3311
Fax Number	:	904-277-3343

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	TIMOTHY D LUCEY
Credential	:	D.O.
Telephone Number	:	904-277-3311

Provider Enumeration Date	:	08/06/2008
Last Update Date	:	12/06/2016

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