Individual
MRS. KELLI LUGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
P.A.
Contact information
Practice address
7710 S US HIGHWAY 1, PORT ST LUCIE, FL 34952-2320
(772) 446-7209
(772) 200-2131
Mailing address
7710 S US HIGHWAY 1, PORT ST LUCIE, FL 34952-2320
(772) 446-7209
(772) 200-2131
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9107919
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPA174151
MEDICARE IDENTIFICATION NUMBER
FL
Enumeration date
08/04/2006
Last updated
09/17/2024
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