Provider Demographics
NPI:1669141396
Name:LUGO, THOMAS JAMES (FNP)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:LUGO
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11521 N FM 620 RD STE 945
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78726-1115
Mailing Address - Country:US
Mailing Address - Phone:125-318-2559
Mailing Address - Fax:
Practice Address - Street 1:11521 N FM 620 RD STE 945
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78726-1115
Practice Address - Country:US
Practice Address - Phone:512-318-2559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX895346163WE0003X
TX1098294363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WE0003XNursing Service ProvidersRegistered NurseEmergency