Healthcare Provider Details

I. General information

NPI: 1871178335
Provider Name (Legal Business Name): ALEXANDRA LACEY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ALEXANDRA COLACINO

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 05/01/2023
Certification Date: 05/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

216 JEAN DR
HUBBARD OH
44425-1665
US

IV. Provider business mailing address

525 E MARKET ST
AKRON OH
44304-1619
US

V. Phone/Fax

Practice location:
  • Phone: 330-984-1620
  • Fax:
Mailing address:
  • Phone: 330-375-3043
  • Fax: 330-706-4856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number57007374RX
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: