Provider Demographics
NPI:1154855344
Name:BURGOS, LUCIDALIA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LUCIDALIA
Middle Name:
Last Name:BURGOS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10131 W COLONIAL DR STE 4
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4221
Mailing Address - Country:US
Mailing Address - Phone:407-982-4852
Mailing Address - Fax:407-604-6323
Practice Address - Street 1:10131 W COLONIAL DR STE 4
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4221
Practice Address - Country:US
Practice Address - Phone:407-982-4852
Practice Address - Fax:407-604-6323
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-14
Last Update Date:2020-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP2807732363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology