Provider Demographics
NPI:1336350248
Name:LUCIANO URGENT CARE
Entity Type:Organization
Organization Name:LUCIANO URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCIANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-291-2221
Mailing Address - Street 1:3364 COUNTY ROAD 220
Mailing Address - Street 2:
Mailing Address - City:MIDDLEBURG
Mailing Address - State:FL
Mailing Address - Zip Code:32068-4359
Mailing Address - Country:US
Mailing Address - Phone:904-291-2221
Mailing Address - Fax:904-291-9192
Practice Address - Street 1:3364 COUNTY ROAD 220
Practice Address - Street 2:
Practice Address - City:MIDDLEBURG
Practice Address - State:FL
Practice Address - Zip Code:32068-4359
Practice Address - Country:US
Practice Address - Phone:904-291-2221
Practice Address - Fax:904-291-9192
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0074540261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG12613Medicare UPIN