MEDICARE: MS. ANGELA JUNE LUCAS FNP-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	363LF0000X	Family Nurse Practitioner	0024172200	VA
2	363LF0000X	Family Nurse Practitioner	5007419	NC
3	363LF0000X	Family Nurse Practitioner	ARNP 9196062	FL

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	:	1811385354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANGELA JUNE LUCAS FNP-C

Provider Business Mailing Address
First Line	:	6403 SE 55TH ST
Second Line	:
City	:	TRENTON
State	:	FL
Zip	:	32693-3024
Country	:	US
Telephone Number	:	828-490-0819
Fax Number	:

Provider Business Practice Location Address
First Line	:	1300 SW SAINT LUCIE WEST BLVD
Second Line	:	MINUTECLINIC
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34986-2109
Country	:	US
Telephone Number	:	772-878-7078
Fax Number	:

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

Provider Enumeration Date	:	01/07/2015
Last Update Date	:	04/20/2021

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