Provider Demographics
NPI:1104932623
Name:LACEY CRANDALL, LYNNE M (MS, CNS, ARNP)
Entity type:Individual
Prefix:MISS
First Name:LYNNE
Middle Name:M
Last Name:LACEY CRANDALL
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Gender:F
Credentials:MS, CNS, ARNP
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Mailing Address - Street 1:13815 TAMIAMI TRL
Mailing Address - Street 2:NORTH PORT MEDICAL CENTER
Mailing Address - City:NORTH PORT
Mailing Address - State:FL
Mailing Address - Zip Code:34287-2069
Mailing Address - Country:US
Mailing Address - Phone:941-426-4900
Mailing Address - Fax:941-426-3994
Practice Address - Street 1:13815 TAMIAMI TRL
Practice Address - Street 2:NORTH PORT MEDICAL CENTER
Practice Address - City:NORTH PORT
Practice Address - State:FL
Practice Address - Zip Code:34287-2069
Practice Address - Country:US
Practice Address - Phone:941-426-4900
Practice Address - Fax:941-426-3994
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
FLARNP3380712363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner