Provider Demographics
NPI:1053745489
Name:LUCAS, LAUREN (ARNP, FNP)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:ARNP, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 VERONICA S SHOEMAKER BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:
Practice Address - Street 1:1630 SE 18TH ST STE 602
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5472
Practice Address - Country:US
Practice Address - Phone:352-369-0181
Practice Address - Fax:352-369-0246
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2016-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9219527363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009419100Medicaid
FLARNP9219527OtherSTATE LICENSE
FLIS196ZMedicare PIN