MEDICARE: ERICA DANIELLE LUONG ARNP

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	363L00000X	Nurse Practitioner	11018691	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11008691	OTHER	FL	APRN LICENSE

General Provider Information

NPI Number	:	1487393906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ERICA DANIELLE LUONG ARNP

Provider Business Mailing Address
First Line	:	5150 PALM VALLEY RD STE 208
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-4632
Country	:	US
Telephone Number	:	904-747-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	5150 PALM VALLEY RD STE 208
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32082-4632
Country	:	US
Telephone Number	:	904-747-8830
Fax Number	:

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

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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