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NPI Code Detail

MEDICARE: COURTNEY ERIN LACY PA-S

MEDICARE: COURTNEY ERIN LACY PA-S
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
1390200000XStudent in an Organized Health Care Education/Training ProgramFL

General Provider Information

NPI Number : 1295662393
Entity Type Code : Individual
Provider Name (Legal Business Name) : COURTNEY ERIN LACY PA-S
Provider Business Mailing Address
First Line : 5249 CHEYENNE MOON
Second Line :
City : CARMEL
State : IN
Zip : 46033-8897
Country : US
Telephone Number : 317-750-8455
Fax Number :
Provider Business Practice Location Address
First Line : 9981 S HEALTHPARK DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33908-3618
Country : US
Telephone Number : 239-342-5000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/05/2026
Last Update Date : 05/05/2026

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Directions to “ COURTNEY ERIN LACY PA-S” Practice Location

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