Provider Demographics
NPI:1184126427
Name:PERCEVAL, LUCIENNE
Entity type:Individual
Prefix:
First Name:LUCIENNE
Middle Name:
Last Name:PERCEVAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:453 N KIRKMAN RD STE 203
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32811-1109
Mailing Address - Country:US
Mailing Address - Phone:407-914-2325
Mailing Address - Fax:407-826-1592
Practice Address - Street 1:453 N KIRKMAN RD STE 203
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32811-1109
Practice Address - Country:US
Practice Address - Phone:407-914-2325
Practice Address - Fax:407-826-1592
Is Sole Proprietor?:No
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9251266363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily