Provider Demographics
NPI:1568692366
Name:LUCAS, BROOKE JANEL (PA)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:JANEL
Last Name:LUCAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:BROOKE
Other - Middle Name:JANEL
Other - Last Name:ROBB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:3049 FENMARCH ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89135-2154
Mailing Address - Country:US
Mailing Address - Phone:702-254-4444
Mailing Address - Fax:
Practice Address - Street 1:7980 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-1990
Practice Address - Country:US
Practice Address - Phone:702-254-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-15
Last Update Date:2019-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA06305363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant