Provider Demographics
NPI:1033634944
Name:LUCIO, SAMUEL LUCAS (FNP-C)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:LUCAS
Last Name:LUCIO
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1139 E SONTERRA BLVD STE 405
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78258-4352
Mailing Address - Country:US
Mailing Address - Phone:210-224-4811
Mailing Address - Fax:210-224-1573
Practice Address - Street 1:1139 E SONTERRA BLVD STE 405
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258-4352
Practice Address - Country:US
Practice Address - Phone:210-224-4811
Practice Address - Fax:210-224-1573
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-11
Last Update Date:2022-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP135675363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily