Healthcare Provider Details

I. General information

NPI: 1063196905
Provider Name (Legal Business Name): LACEY VATLAND MORRISON APRN, FNP, PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LACEY VATLAND

II. Dates (important events)

Enumeration Date: 06/12/2023
Last Update Date: 05/17/2026
Certification Date: 05/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4877 A1A
VERO BEACH FL
32963-1279
US

IV. Provider business mailing address

10140 CENTURION PKWY N
JACKSONVILLE FL
32256-0532
US

V. Phone/Fax

Practice location:
  • Phone: 480-864-3870
  • Fax:
Mailing address:
  • Phone: 904-697-4100
  • Fax: 904-697-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberAPRN11027159
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberAPRN11027159
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: