Provider Demographics
NPI:1356674808
Name:LUGO, MANUEL ENRIQUE (PA)
Entity type:Individual
Prefix:
First Name:MANUEL
Middle Name:ENRIQUE
Last Name:LUGO
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2809 AUTUMN BREEZE WAY
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34744-9273
Mailing Address - Country:US
Mailing Address - Phone:407-497-3041
Mailing Address - Fax:
Practice Address - Street 1:14807 E COLONIAL DR STE 112
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-5122
Practice Address - Country:US
Practice Address - Phone:407-250-6742
Practice Address - Fax:407-203-6742
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2025-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9100273363AM0700X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant