Provider Demographics
NPI:1306998174
Name:JERNIGAN, LACY L (ARNP)
Entity type:Individual
Prefix:MRS
First Name:LACY
Middle Name:L
Last Name:JERNIGAN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:MC INTOSH
Mailing Address - State:FL
Mailing Address - Zip Code:32664-0500
Mailing Address - Country:US
Mailing Address - Phone:352-591-9632
Mailing Address - Fax:352-867-7895
Practice Address - Street 1:1901 SE 18TH AVE BLDG 400
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-8215
Practice Address - Country:US
Practice Address - Phone:352-732-8630
Practice Address - Fax:352-867-7895
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9233779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily