Provider Demographics
NPI:1154855344
Name:BURGOS, LUCIDALIA (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LUCIDALIA
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1720 S ORANGE AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2932
Mailing Address - Country:US
Mailing Address - Phone:321-842-9000
Mailing Address - Fax:321-843-6326
Practice Address - Street 1:1720 S ORANGE AVE STE 200
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2932
Practice Address - Country:US
Practice Address - Phone:321-842-9000
Practice Address - Fax:321-843-6326
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2807732363LG0600X
FLAPRN2807732363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology