Tiffany Lake-Luckett

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

209.025453 Issued in IL

Practice address

2340 S Eola Rd Ste 100
Aurora, IL 60503-6410

Phone

(630) 692-5190

Fax

(630) 692-5185

NPI assigned

Jun 1, 2022

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: tlakeluckett589933@direct.ochin.org

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1654041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662681600000",
    "number": "1538808100",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2340 S EOLA RD STE 100",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605036410",
            "telephone_number": "630-692-5190",
            "fax_number": "630-692-5185"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2340 S EOLA RD STE 100",
            "city": "AURORA",
            "state": "IL",
            "postal_code": "605036410",
            "telephone_number": "630-692-5190",
            "fax_number": "630-692-5185"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "400 N Highland Ave",
            "address_purpose": "LOCATION",
            "city": "Aurora",
            "state": "IL",
            "postal_code": "605063814",
            "country_code": "US",
            "telephone_number": "630-978-2532",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "LAKE-LUCKETT",
        "first_name": "TIFFANY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-06-01",
        "last_updated": "2022-09-09",
        "certification_date": "2022-09-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "IL",
            "license": "209.025453",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Elizabeth Rebecca La Ha
• Robert A Labak, MSSW, LCSW
• Rosalva Lacke
• Jo Ann Jaen Lagman, M.D.
• Lake Street Optical
• Kamala Lakshmipathy
• Mary Ellen Laloggia, M.A,
• Deanna Marie Lamartina, CPNP-PC
• Ryan Lambe, PT, DPT
• Benjamin C Lambert

• Family Nurse Practitioner in Aurora, IL
• Providers in Aurora, IL by specialty
• Family Nurse Practitioner in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 9, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.