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General NPI Number Information
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NPI Number | 1457469769
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Entity Type | Individual
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Provider Name | JENNIFER REBECCA LACY CRNP
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Gender | Female
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Dates
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Enumeration Date | 08/27/2006
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Last Update Date | 12/19/2024
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Provider Practice Location Address
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Address Line | 10000 ANNS CHOICE WAY
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City | WARMINSTER
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State | PA
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Zip | 18974-3527
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Country | US
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Telephone | 215-443-3850
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Fax | 215-443-3963
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Provider Business Mailing Address
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Address Line | 5730 EXECUTIVE DR STE 230
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City | CATONSVILLE
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State | MD
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Zip | 21228-1762
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Country | US
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Telephone | 215-443-8350
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Fax | 215-443-3963
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | SP007754
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | SP00755
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License Number State | PA
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