Provider Demographics
NPI:1275683351
Name:GILDEA, LUCIA ANN (RPA-C)
Entity Type:Individual
Prefix:MS
First Name:LUCIA
Middle Name:ANN
Last Name:GILDEA
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 GRANNY RD
Mailing Address - Street 2:STE 1
Mailing Address - City:FARMINGVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11738-2879
Mailing Address - Country:US
Mailing Address - Phone:631-696-4357
Mailing Address - Fax:
Practice Address - Street 1:1350 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-3224
Practice Address - Country:US
Practice Address - Phone:631-422-6166
Practice Address - Fax:631-422-6266
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ00233000363AS0400X
NY012808363AS0400X
FLPA9105480363AS0400X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPENDINGMedicaid
FLIZ176ZOtherMEDICARE
NYA400068133Medicare PIN