Provider Demographics
NPI:1548455660
Name:LUGO, KHRISTOPHER MICHAEL (PA)
Entity type:Individual
Prefix:MR
First Name:KHRISTOPHER
Middle Name:MICHAEL
Last Name:LUGO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3644 HENDERSON BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4502
Mailing Address - Country:US
Mailing Address - Phone:844-789-2266
Mailing Address - Fax:813-260-2411
Practice Address - Street 1:3644 HENDERSON BLVD STE B
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609
Practice Address - Country:US
Practice Address - Phone:844-789-2266
Practice Address - Fax:813-260-2411
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-11
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI100638363A00000X
FLPA9101888363AS0400X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical