Provider Demographics
NPI:1386322717
Name:LUCAS, ANGELA KATE
Entity type:Individual
Prefix:
First Name:ANGELA
Middle Name:KATE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7901 BAYMEADOWS WAY STE 5
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-8535
Mailing Address - Country:US
Mailing Address - Phone:917-683-8266
Mailing Address - Fax:
Practice Address - Street 1:7901 BAYMEADOWS WAY STE 5
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-8535
Practice Address - Country:US
Practice Address - Phone:904-414-3796
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-06
Last Update Date:2023-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL40332225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL40332OtherFLORIDA DEPARTMENT OF HEALTH