Healthcare Provider Details

I. General information

NPI: 1427961697
Provider Name (Legal Business Name): LACEY JORDY APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 TRENTON RD
BROWNS MILLS NJ
08015-1764
US

IV. Provider business mailing address

24725 E MAIN ST
COLUMBUS NJ
08022-1319
US

V. Phone/Fax

Practice location:
  • Phone: 609-893-1200
  • Fax:
Mailing address:
  • Phone: 609-553-3278
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number26NJ15665500
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: