MEDICARE: EMILY LUCERO EMILY

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	164W00000X	Licensed Practical Nurse	5192795	FL

General Provider Information

NPI Number	:	1588225163
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EMILY LUCERO EMILY

Provider Business Mailing Address
First Line	:	103 OYSTER BAY CIR APT 230
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-8013
Country	:	US
Telephone Number	:	407-879-2035
Fax Number	:

Provider Business Practice Location Address
First Line	:	103 OYSTER BAY CIR APT 230
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-8013
Country	:	US
Telephone Number	:	407-879-2035
Fax Number	:

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	06/25/2019

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