Provider Demographics
NPI:1669046363
Name:LUTCHKUS, ERIN ANN
Entity type:Individual
Prefix:
First Name:ERIN
Middle Name:ANN
Last Name:LUTCHKUS
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 1:2054 VISTA PKWY STE 400
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-6742
Mailing Address - Country:US
Mailing Address - Phone:561-231-0233
Mailing Address - Fax:561-203-3447
Practice Address - Street 1:2054 VISTA PKWY STE 400
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-6742
Practice Address - Country:US
Practice Address - Phone:561-231-0233
Practice Address - Fax:561-203-3447
Is Sole Proprietor?:No
Enumeration Date:2021-05-17
Last Update Date:2024-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9482930163W00000X
COC-APN.0003020-C-NP363LP0808X
FLAPRN11013853363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000193691Medicaid