MEDICARE: STEPHANIE REGAN LACEY DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	OS9818	FL
2	2080P0202X	Pediatric Cardiology Physician	OS9818	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992741342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE REGAN LACEY DO

Provider Business Mailing Address
First Line	:	PO BOX 44008
Second Line	:	UFJP PROVIDER ENROLLMENT
City	:	JACKSONVILLE
State	:	FL
Zip	:	32231-4008
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	841 PRUDENTIAL DR
Second Line	:	UFJP PEDIATRIC CARDIOLOGY
City	:	JACKSONVILLE
State	:	FL
Zip	:	32207-8329
Country	:	US
Telephone Number	:	904-493-1610
Fax Number	:	904-493-2363

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2006
Last Update Date	:	04/23/2010

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Directions to “ STEPHANIE REGAN LACEY DO” Practice Location

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