Provider Demographics
NPI:1528296068
Name:LUCAS, TANYA (WHNP)
Entity type:Individual
Prefix:MS
First Name:TANYA
Middle Name:
Last Name:LUCAS
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1515 SOUTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10460
Mailing Address - Country:US
Mailing Address - Phone:718-860-8595
Mailing Address - Fax:718-991-3824
Practice Address - Street 1:4 SKYLINE DR
Practice Address - Street 2:SUITE 7
Practice Address - City:HAWTHORNE
Practice Address - State:NY
Practice Address - Zip Code:10532-2147
Practice Address - Country:US
Practice Address - Phone:914-467-7343
Practice Address - Fax:914-418-1042
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY488352-1163W00000X
NYF420900-1363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY3452884Medicaid