Provider Demographics
NPI:1053344127
Name:LUCY C LOVE MD PA
Entity type:Organization
Organization Name:LUCY C LOVE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LUCY
Authorized Official - Middle Name:C
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-971-2888
Mailing Address - Street 1:3000 E FLETCHER AVE STE 230
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4644
Mailing Address - Country:US
Mailing Address - Phone:813-971-2888
Mailing Address - Fax:813-971-3787
Practice Address - Street 1:3000 E FLETCHER AVE STE 230
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4644
Practice Address - Country:US
Practice Address - Phone:813-971-2888
Practice Address - Fax:813-971-3787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036743207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068863100Medicaid
FL068863100Medicaid
FLD54096Medicare UPIN