Provider Demographics
NPI:1417905621
Name:TROVATO, LUCY MARINA (NP)
Entity Type:Individual
Prefix:MRS
First Name:LUCY
Middle Name:MARINA
Last Name:TROVATO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4855 W HILLSBORO BLVD STE B13
Mailing Address - Street 2:
Mailing Address - City:COCONUT CREEK
Mailing Address - State:FL
Mailing Address - Zip Code:33073-4365
Mailing Address - Country:US
Mailing Address - Phone:954-480-9182
Mailing Address - Fax:954-420-9184
Practice Address - Street 1:4855 W HILLSBORO BLVD STE B13
Practice Address - Street 2:
Practice Address - City:COCONUT CREEK
Practice Address - State:FL
Practice Address - Zip Code:33073-4365
Practice Address - Country:US
Practice Address - Phone:954-420-9182
Practice Address - Fax:954-420-9184
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2017-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9396948363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJPENDINGMedicare UPIN
NJPENDINGMedicare UPIN