Provider Demographics
NPI:1811057318
Name:LUCEY, TIMOTHY D (DO)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:D
Last Name:LUCEY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 S 18TH ST STE 104
Mailing Address - Street 2:
Mailing Address - City:FERNANDINA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32034-4733
Mailing Address - Country:US
Mailing Address - Phone:904-277-3311
Mailing Address - Fax:904-390-7438
Practice Address - Street 1:1340 S 18TH ST STE 104
Practice Address - Street 2:
Practice Address - City:FERNANDINA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32034-4733
Practice Address - Country:US
Practice Address - Phone:904-277-3311
Practice Address - Fax:904-390-7438
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2022-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS104122084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology