Provider Demographics
NPI:1801030739
Name:TANN, LUCIANA (PA)
Entity Type:Individual
Prefix:
First Name:LUCIANA
Middle Name:
Last Name:TANN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:LUCIANA
Other - Middle Name:
Other - Last Name:ROZAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:5100 BURCHETTE RD
Mailing Address - Street 2:UNIT 705
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-1504
Mailing Address - Country:US
Mailing Address - Phone:954-804-1140
Mailing Address - Fax:
Practice Address - Street 1:13610 BRUCE B DOWNS BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4650
Practice Address - Country:US
Practice Address - Phone:813-977-2777
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-22
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9104829363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001182400Medicaid
FL001182400Medicaid