MEDICARE: JASMINE MAY LUCK 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	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1801665468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASMINE MAY LUCK PA-C

Provider Business Mailing Address
First Line	:	2137 16TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-3923
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2137 16TH ST N
Second Line	:
City	:	ST PETERSBURG
State	:	FL
Zip	:	33704-3923
Country	:	US
Telephone Number	:	727-822-1896
Fax Number	:	727-821-0932

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

Provider Enumeration Date	:	12/25/2023
Last Update Date	:	05/21/2024

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Directions to “ JASMINE MAY LUCK PA-C” Practice Location

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