Provider Demographics
NPI:1972147874
Name:LUCZKA, JENNA (PA-C)
Entity Type:Individual
Prefix:
First Name:JENNA
Middle Name:
Last Name:LUCZKA
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 1:2006 REVERE DR
Mailing Address - Street 2:
Mailing Address - City:CONNELLSVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15425-1523
Mailing Address - Country:US
Mailing Address - Phone:724-322-3957
Mailing Address - Fax:
Practice Address - Street 1:100 RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-1650
Practice Address - Country:US
Practice Address - Phone:724-569-8100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-04
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA0611822080T0004X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2080T0004XAllopathic & Osteopathic PhysiciansPediatricsPediatric Transplant Hepatology