Provider Demographics
NPI:1972634111
Name:LOVE, LUCY C (MD)
Entity Type:Individual
Prefix:
First Name:LUCY
Middle Name:C
Last Name:LOVE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 E FLETCHER AVE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4656
Mailing Address - Country:US
Mailing Address - Phone:813-971-2888
Mailing Address - Fax:813-971-3787
Practice Address - Street 1:3000 E FLETCHER AVE
Practice Address - Street 2:SUITE 230
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4656
Practice Address - Country:US
Practice Address - Phone:813-971-2888
Practice Address - Fax:813-971-3787
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0036743207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL068863100Medicaid
FLD5406Medicare UPIN
FL068863100Medicaid