Individual
JESSICA E LUCCA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGACNP-BC
Contact information
Practice address
319 E MADISON ST STE 1F, SPRINGFIELD, IL 62701-3118
(217) 788-3948
(217) 527-3209
Mailing address
PO BOX 3428, SPRINGFIELD, IL 62708-3428
(217) 788-3948
(217) 527-3209
Taxonomy
Speciality
Code
Description
License number
State
207RC0001X
Clinical Cardiac Electrophysiology Physician
209.012661
IL
363L00000X
Nurse Practitioner
209012661
IL
363LA2100X
Acute Care Nurse Practitioner
Primary
209.012661
IL
363LG0600X
Gerontology Nurse Practitioner
209.012661
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
041.375925
RN LICENSE
IL
Enumeration date
04/01/2015
Last updated
12/23/2019
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