Active NPI
Dede Luczak, OWNER
- Other Technician
- Jacksonville, FL
National Provider Identifier
1225419260
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- CGC062824
- Practice address
- 2600 Seneca Dr
Jacksonville, FL 32259-2117 - Phone
- (904) 449-1496
- Fax
- (904) 436-5977
- NPI assigned
- Jun 16, 2015
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | CGC062824 | FL | Primary |
Addresses
Primary practice location
2600 Seneca Dr
Jacksonville, FL 32259-2117
Mailing address
2600 Seneca Dr
Jacksonville, FL 32259-2117
Phone (904) 449-1496
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| CGC062824 | FL | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1434412800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1434412800000",
"number": "1225419260",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 SENECA DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322592117",
"telephone_number": "904-449-1496",
"fax_number": "904-436-5977"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2600 SENECA DR",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322592117",
"telephone_number": "904-449-1496",
"fax_number": "904-436-5977"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUCZAK",
"first_name": "DEDE",
"name_prefix": "Mrs.",
"credential": "OWNER",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-06-16",
"last_updated": "2015-06-16",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "FL",
"license": "CGC062824",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.