Provider Demographics
NPI:1427646942
Name:LUCAS, REBECCA DIANE (FNP-BC, AGACNP-BC)
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:DIANE
Last Name:LUCAS
Suffix:
Gender:F
Credentials:FNP-BC, AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:62 SAINT LO CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80902-1700
Mailing Address - Country:US
Mailing Address - Phone:808-292-2844
Mailing Address - Fax:
Practice Address - Street 1:975 GARDEN OF THE GODS RD STE E
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-3434
Practice Address - Country:US
Practice Address - Phone:719-694-8782
Practice Address - Fax:719-694-9375
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-10
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMSAPN.0000026-NP363LA2100X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty