Provider Demographics
NPI:1912236290
Name:LUGOS, NICOLE L (MSN, APRN, ACNP)
Entity type:Individual
Prefix:MRS
First Name:NICOLE
Middle Name:L
Last Name:LUGOS
Suffix:
Gender:F
Credentials:MSN, APRN, ACNP
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:NICOLE
Other - Last Name:LAFRAGE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSN, APRN, ACNP
Mailing Address - Street 1:116 CROWN COLONY CT
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29073-7144
Mailing Address - Country:US
Mailing Address - Phone:803-996-5343
Mailing Address - Fax:
Practice Address - Street 1:12425 RACE TRACK RD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-3102
Practice Address - Country:US
Practice Address - Phone:800-776-7713
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC3325363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care