Provider Demographics
NPI:1114930633
Name:DELUCA, JOSEPH NICHOLAS (MD, PHD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:NICHOLAS
Last Name:DELUCA
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:378 CENTER POINTE CIRCLE
Mailing Address - Street 2:SUITE 1280
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-3442
Mailing Address - Country:US
Mailing Address - Phone:407-862-5959
Mailing Address - Fax:407-774-5573
Practice Address - Street 1:378 CENTER POINTE CIRCLE
Practice Address - Street 2:SUITE 1280
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-3442
Practice Address - Country:US
Practice Address - Phone:407-862-5959
Practice Address - Fax:407-774-5573
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003384103TC0700X
FLME0050155208D00000X
FLME50155208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL046585200Medicaid
FL046585200Medicaid
D50662Medicare UPIN