Provider Demographics
NPI:1770268823
Name:MCCREA, LUCINDA
Entity type:Individual
Prefix:
First Name:LUCINDA
Middle Name:
Last Name:MCCREA
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 1:1109 WYNNMERE WALK AVE
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33570-2069
Mailing Address - Country:US
Mailing Address - Phone:727-831-2862
Mailing Address - Fax:813-938-3252
Practice Address - Street 1:1109 WYNNMERE WALK AVE
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-2069
Practice Address - Country:US
Practice Address - Phone:727-831-2862
Practice Address - Fax:813-938-3252
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-16
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6907077311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home