Provider Demographics
NPI:1548395775
Name:LUCE, VERNON GRANT (PA-C)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:GRANT
Last Name:LUCE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:GRANT
Other - Middle Name:
Other - Last Name:LUCE
Other - Suffix:I
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:1950 ARLINGTON ST
Mailing Address - Street 2:STE 400
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-3513
Mailing Address - Country:US
Mailing Address - Phone:941-917-4250
Mailing Address - Fax:941-917-4257
Practice Address - Street 1:1950 ARLINGTON ST
Practice Address - Street 2:STE 400
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-3513
Practice Address - Country:US
Practice Address - Phone:941-917-4250
Practice Address - Fax:941-917-4257
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104009363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL007859900Medicaid
FLAC762XMedicare PIN
FL007859900Medicaid