Provider Demographics
NPI:1972108579
Name:EUSTACHE, LOCKLEAR (DNP)
Entity Type:Individual
Prefix:DR
First Name:LOCKLEAR
Middle Name:
Last Name:EUSTACHE
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:790 E BROWARD BLVD APT 1502
Mailing Address - Street 2:
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3069
Mailing Address - Country:US
Mailing Address - Phone:954-663-0347
Mailing Address - Fax:
Practice Address - Street 1:3000 NW 130TH TER APT 325
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-3938
Practice Address - Country:US
Practice Address - Phone:954-663-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2022-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9356295163W00000X
FLAPRN11015316367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse