Provider Demographics
NPI:1568211985
Name:LUZINCOURT, MANOUCHEKA (FNP)
Entity type:Individual
Prefix:
First Name:MANOUCHEKA
Middle Name:
Last Name:LUZINCOURT
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2021 SW 15TH AVE APT G201
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33426-6396
Mailing Address - Country:US
Mailing Address - Phone:561-293-1154
Mailing Address - Fax:
Practice Address - Street 1:2021 SW 15TH AVE APT G201
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-6396
Practice Address - Country:US
Practice Address - Phone:561-293-1154
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-17
Last Update Date:2024-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL672541363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily