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General NPI Number Information
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NPI Number | 1992107296
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Entity Type | Individual
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Provider Name | AASTASSHIA LYNN LACY FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/18/2014
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 9220 SPRINGHILL LN
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City | GREENBELT
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State | MD
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Zip | 20770-1203
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Country | US
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Telephone | 240-624-2323
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Fax | 240-624-2029
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Provider Business Mailing Address
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Address Line | 8665 GEORGIA AVE
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City | SILVER SPRING
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State | MD
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Zip | 20910-3405
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Country | US
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Telephone | 301-340-7525
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Fax | 301-495-0318
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 0024172066
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | R187768
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License Number State | MD
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