Healthcare Provider Details

I. General information

NPI: 1194446617
Provider Name (Legal Business Name): LACEY JEAN BARTA FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2022
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13771 N FOUNTAIN HILLS BLVD
FOUNTAIN HILLS AZ
85268-3762
US

IV. Provider business mailing address

13771 N FOUNTAIN HILLS BLVD
FOUNTAIN HILLS AZ
85268-3762
US

V. Phone/Fax

Practice location:
  • Phone: 888-662-3376
  • Fax:
Mailing address:
  • Phone: 888-662-3376
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF04220494
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number193326
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: