MEDICARE: DR. LOCKLEAR EUSTACHE DNP

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	163W00000X	Registered Nurse	RN9356295	FL
2	367500000X	Certified Registered Nurse Anesthetist	APRN11015316	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	:	1972108579
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LOCKLEAR EUSTACHE DNP

Provider Business Mailing Address
First Line	:	790 E BROWARD BLVD APT 1502
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33301-3069
Country	:	US
Telephone Number	:	954-663-0347
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 NW 130TH TER APT 325
Second Line	:
City	:	SUNRISE
State	:	FL
Zip	:	33323-3938
Country	:	US
Telephone Number	:	954-663-0347
Fax Number	:

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

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	07/02/2022

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