Provider Demographics
NPI:1275642043
Name:ROBERTS, LUCY DUQUE (ARNP)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:DUQUE
Last Name:ROBERTS
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 1:766 N SUN DR
Mailing Address - Street 2:STE 2060
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746
Mailing Address - Country:US
Mailing Address - Phone:407-936-3860
Mailing Address - Fax:407-936-3866
Practice Address - Street 1:766 N. SUN DRIVE
Practice Address - Street 2:SUITE 2060
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746
Practice Address - Country:US
Practice Address - Phone:407-936-3860
Practice Address - Fax:407-936-3866
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1449212363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU2111ZMedicare PIN
FLQ10565Medicare UPIN