Provider Demographics
NPI:1659402949
Name:KODAN, LUCIA V (ARNP)
Entity Type:Individual
Prefix:MISS
First Name:LUCIA
Middle Name:V
Last Name:KODAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 NE 191ST ST
Mailing Address - Street 2:SUITE -A 401
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33179-4200
Mailing Address - Country:US
Mailing Address - Phone:305-588-4258
Mailing Address - Fax:
Practice Address - Street 1:1701 NE 191 STREET
Practice Address - Street 2:SUITE A 401
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33179
Practice Address - Country:US
Practice Address - Phone:305-588-4258
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3006432363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE3719CMedicare PIN