Provider Demographics
NPI:1942494265
Name:LUKAS, CLAUDIA LAUREN (PAC)
Entity Type:Individual
Prefix:
First Name:CLAUDIA
Middle Name:LAUREN
Last Name:LUKAS
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 5TH ST S
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33701-4804
Mailing Address - Country:US
Mailing Address - Phone:727-767-4176
Mailing Address - Fax:727-767-4379
Practice Address - Street 1:601 5TH ST S
Practice Address - Street 2:3RD FLOOR
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33701-4804
Practice Address - Country:US
Practice Address - Phone:727-767-4176
Practice Address - Fax:727-767-4379
Is Sole Proprietor?:No
Enumeration Date:2007-08-29
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102259363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002766900Medicaid