Provider Demographics
NPI:1174418446
Name:MOREIRA, LUCIANA
Entity type:Individual
Prefix:
First Name:LUCIANA
Middle Name:
Last Name:MOREIRA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9941 SUMMERLAKE GROVES ST
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-4497
Mailing Address - Country:US
Mailing Address - Phone:774-204-2617
Mailing Address - Fax:
Practice Address - Street 1:10000 W COLONIAL DR STE 289
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-3432
Practice Address - Country:US
Practice Address - Phone:321-842-4765
Practice Address - Fax:321-842-4767
Is Sole Proprietor?:No
Enumeration Date:2025-06-09
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11040479363LF0000X
FLAPRN11040479363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily