Healthcare Provider Details

I. General information

NPI: 1992107296
Provider Name (Legal Business Name): AASTASSHIA LYNN LACY FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AASTASSHIA LYNN LACY FNP-BC

II. Dates (important events)

Enumeration Date: 09/18/2014
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 GREENMOUNT AVE
BALTIMORE MD
21218-4991
US

IV. Provider business mailing address

3030 GREENMOUNT AVE
BALTIMORE MD
21218-4991
US

V. Phone/Fax

Practice location:
  • Phone: 410-870-9567
  • Fax: 410-934-1100
Mailing address:
  • Phone: 410-870-9567
  • Fax: 410-934-1100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number0024172066
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR187768
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: