| Doctor Name: | MRS. TINA FAYE LUCK |
| NPI Number: | 1033549670 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | FNP-C |
| License Number: | AP124485 |
| Business Practice Address: | 4241 Southwest Blvd San Angelo, TX - 769045687 |
| Business Phone Number: | 3255005026 |
| Business Fax Number: | 3259473018 |
| Mailing Address: | 3005 Grandview Dr, SAN ANGELO |
| State: | TX |
| Postal Code: | 769048145 |
| Phone Number: | 3252262462 |
| Fax Number: | |
| NPI Enumeration Date: | 11/18/2013 |
| NPI Last Update Date: | 05/25/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | AP124485 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | TX |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |