Provider Demographics
NPI:1477719656
Name:TIMOTHY LUCEY DO PLLC
Entity Type:Organization
Organization Name:TIMOTHY LUCEY DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:D
Authorized Official - Last Name:LUCEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:904-277-3311
Mailing Address - Street 1:PO BOX 15718
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32035-3112
Mailing Address - Country:US
Mailing Address - Phone:904-277-3311
Mailing Address - Fax:904-277-3343
Practice Address - Street 1:1865 LIME ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4779
Practice Address - Country:US
Practice Address - Phone:904-277-3311
Practice Address - Fax:904-277-3343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-06
Last Update Date:2016-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS104122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty