Provider Demographics
NPI:1992148167
Name:GAUSIK, LUCA (MD)
Entity type:Individual
Prefix:
First Name:LUCA
Middle Name:
Last Name:GAUSIK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:S
Other - Last Name:CRONIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:85010 DAVID RD
Mailing Address - Street 2:
Mailing Address - City:YULEE
Mailing Address - State:FL
Mailing Address - Zip Code:32097-4590
Mailing Address - Country:US
Mailing Address - Phone:904-955-3987
Mailing Address - Fax:
Practice Address - Street 1:85010 DAVID RD
Practice Address - Street 2:
Practice Address - City:YULEE
Practice Address - State:FL
Practice Address - Zip Code:32097-4590
Practice Address - Country:US
Practice Address - Phone:904-955-3987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-08
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME112755208D00000X
CODR.0067033208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice