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General NPI Number Information
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NPI Number | 1649002064
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Entity Type | Individual
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Provider Name | TINIYA BRANDY LACY NP
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Gender | Female
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Dates
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Enumeration Date | 08/14/2024
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Last Update Date | 03/30/2026
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Provider Practice Location Address
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Address Line | 18522 US HIGHWAY 18 STE 102
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City | APPLE VALLEY
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State | CA
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Zip | 92307-2321
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Country | US
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Telephone | 760-242-7707
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Fax | 760-242-1133
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Provider Business Mailing Address
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Address Line | 11797 FOREST PARK LN
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City | VICTORVILLE
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State | CA
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Zip | 92392-0428
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Country | US
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Telephone | 760-662-9940
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Fax |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95046480
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95039016
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License Number State | CA
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