MEDICARE: MISS LYNNE M LACEY CRANDALL MS, CNS, ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	ARNP3380712	FL

General Provider Information

NPI Number	:	1104932623
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS LYNNE M LACEY CRANDALL MS, CNS, ARNP

Provider Business Mailing Address
First Line	:	13815 TAMIAMI TRL
Second Line	:	NORTH PORT MEDICAL CENTER
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2069
Country	:	US
Telephone Number	:	941-426-4900
Fax Number	:	941-426-3994

Provider Business Practice Location Address
First Line	:	13815 TAMIAMI TRL
Second Line	:	NORTH PORT MEDICAL CENTER
City	:	NORTH PORT
State	:	FL
Zip	:	34287-2069
Country	:	US
Telephone Number	:	941-426-4900
Fax Number	:	941-426-3994

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2006
Last Update Date	:	07/08/2007

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