Provider Demographics
NPI:1487411039
Name:LUSTREA, IOANA MELANIA (APRN)
Entity type:Individual
Prefix:
First Name:IOANA
Middle Name:MELANIA
Last Name:LUSTREA
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13715 RICHMOND PARK DR N UNIT 401
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-5277
Mailing Address - Country:US
Mailing Address - Phone:904-593-8514
Mailing Address - Fax:904-593-8515
Practice Address - Street 1:13715 RICHMOND PARK DR N UNIT 401
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32224-5277
Practice Address - Country:US
Practice Address - Phone:904-593-8514
Practice Address - Fax:904-593-8515
Is Sole Proprietor?:Yes
Enumeration Date:2024-02-29
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9234293208M00000X
FL11027722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist