Provider Demographics
NPI:1992107296
Name:LACY, AASTASSHIA LYNN (FNP-BC)
Entity type:Individual
Prefix:MRS
First Name:AASTASSHIA
Middle Name:LYNN
Last Name:LACY
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:MRS
Other - First Name:AASTASSHIA
Other - Middle Name:LYNN
Other - Last Name:LACY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:FNP-BC
Mailing Address - Street 1:8665 GEORGIA AVE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3405
Mailing Address - Country:US
Mailing Address - Phone:301-340-7525
Mailing Address - Fax:301-495-0318
Practice Address - Street 1:9220 SPRINGHILL LN
Practice Address - Street 2:
Practice Address - City:GREENBELT
Practice Address - State:MD
Practice Address - Zip Code:20770-1203
Practice Address - Country:US
Practice Address - Phone:240-624-2323
Practice Address - Fax:240-624-2029
Is Sole Proprietor?:No
Enumeration Date:2014-09-18
Last Update Date:2024-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024172066363L00000X
MDR187768363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0024172066OtherSTATE LICENSE
MDR187768OtherMARYLAND STATE BOARD OF NURSING