Provider Demographics
NPI:1689208274
Name:VELAZQUEZ-LUCENA, DERICK J (MD, MHA)
Entity Type:Individual
Prefix:DR
First Name:DERICK
Middle Name:J
Last Name:VELAZQUEZ-LUCENA
Suffix:
Gender:M
Credentials:MD, MHA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 S HARBOUR ISLAND BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33602-5925
Mailing Address - Country:US
Mailing Address - Phone:727-322-3439
Mailing Address - Fax:800-928-7449
Practice Address - Street 1:11317 LAKE UNDERHILL RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32825-4435
Practice Address - Country:US
Practice Address - Phone:407-499-5900
Practice Address - Fax:844-388-6186
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-24
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDCATEMP-012231208D00000X
PR21618208D00000X
MA475208D00000X
PR13873-I390200000X
PR14128-I390200000X
FLACN1231208D00000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program