Provider Demographics
NPI:1235878661
Name:VERTUS, LUTECE SHANI HOOKS
Entity Type:Individual
Prefix:
First Name:LUTECE
Middle Name:SHANI HOOKS
Last Name:VERTUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 LIBERTY DAY CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32221-1894
Mailing Address - Country:US
Mailing Address - Phone:904-418-1987
Mailing Address - Fax:
Practice Address - Street 1:1500 LIBERTY DAY CT
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32221-1894
Practice Address - Country:US
Practice Address - Phone:904-418-1987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-02
Last Update Date:2022-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL222Q00000XMedicaid