Provider Demographics
NPI:1912348541
Name:CARLUCCI, LINDSAY AGNETA (NP)
Entity type:Individual
Prefix:
First Name:LINDSAY
Middle Name:AGNETA
Last Name:CARLUCCI
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 GRASSY RIDGE TER
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20132-6139
Mailing Address - Country:US
Mailing Address - Phone:703-554-4528
Mailing Address - Fax:
Practice Address - Street 1:204 GRASSY RIDGE TER
Practice Address - Street 2:
Practice Address - City:PURCELLVILLE
Practice Address - State:VA
Practice Address - Zip Code:20132-6139
Practice Address - Country:US
Practice Address - Phone:703-554-4528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-11
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024170999363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily