Provider Demographics
NPI:1588225163
Name:LUCERO, EMILY (EMILY)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:LUCERO
Suffix:
Gender:F
Credentials:EMILY
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:TAING
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 OYSTER BAY CIR APT 230
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-8013
Mailing Address - Country:US
Mailing Address - Phone:407-879-2035
Mailing Address - Fax:
Practice Address - Street 1:103 OYSTER BAY CIR APT 230
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-8013
Practice Address - Country:US
Practice Address - Phone:407-879-2035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL5192795164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse