Provider Demographics
NPI:1972217693
Name:LUKAS, TAYLOR GRACE (DNP, FNP-BC, BSN, RN)
Entity type:Individual
Prefix:DR
First Name:TAYLOR
Middle Name:GRACE
Last Name:LUKAS
Suffix:
Gender:F
Credentials:DNP, FNP-BC, BSN, RN
Other - Prefix:DR
Other - First Name:TAYLOR
Other - Middle Name:GRACE
Other - Last Name:TRIPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DNP, FNP-BC, BSN, RN
Mailing Address - Street 1:5600 STIMSON RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLEVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:49333-9060
Mailing Address - Country:US
Mailing Address - Phone:269-254-5772
Mailing Address - Fax:
Practice Address - Street 1:300 MEADOW RUN DR
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MI
Practice Address - Zip Code:49058-9048
Practice Address - Country:US
Practice Address - Phone:269-818-1020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-09
Last Update Date:2025-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704325315163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse