Healthcare Provider Details

I. General information

NPI: 1346169596
Provider Name (Legal Business Name): LACEY JOSEPH APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8318 MARKET ST
LAKEWOOD RANCH FL
34202-5137
US

IV. Provider business mailing address

6312 113TH TER E
PARRISH FL
34219-3709
US

V. Phone/Fax

Practice location:
  • Phone: 941-855-6483
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11049123
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: