Provider Demographics
NPI:1821391582
Name:BUCK, LAINIE I (PA-C)
Entity Type:Individual
Prefix:
First Name:LAINIE
Middle Name:I
Last Name:BUCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9897 HAGEN RANCH RD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33472-7400
Mailing Address - Country:US
Mailing Address - Phone:561-364-7774
Mailing Address - Fax:
Practice Address - Street 1:1001 NW 13TH ST
Practice Address - Street 2:S. 100
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-2269
Practice Address - Country:US
Practice Address - Phone:561-750-0544
Practice Address - Fax:561-750-9873
Is Sole Proprietor?:No
Enumeration Date:2010-12-17
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07603363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant