MEDICARE: MR. ANTHONY LUCZAK APRN

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	363LP0200X	Pediatric Nurse Practitioner	APO7963	LA
2	363LP0200X	Pediatric Nurse Practitioner	AP07963	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548678055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY LUCZAK APRN

Provider Business Mailing Address
First Line	:	806 JEFFERSON TER
Second Line	:
City	:	NEW IBERIA
State	:	LA
Zip	:	70560-5727
Country	:	US
Telephone Number	:	337-365-4945
Fax Number	:	337-367-3917

Provider Business Practice Location Address
First Line	:	1002 12TH ST
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-6224
Country	:	US
Telephone Number	:	337-534-0107
Fax Number	:	337-534-0184

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	10/22/2019

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