Provider Demographics
NPI:1992319859
Name:LACEY, CARMEL M (MSN, FNP-BC)
Entity type:Individual
Prefix:
First Name:CARMEL
Middle Name:M
Last Name:LACEY
Suffix:
Gender:F
Credentials:MSN, FNP-BC
Other - Prefix:
Other - First Name:CARMEL
Other - Middle Name:M
Other - Last Name:LACEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSN, FNP-BC
Mailing Address - Street 1:1621 SALMONBERRY ST
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33543-8178
Mailing Address - Country:US
Mailing Address - Phone:813-997-7318
Mailing Address - Fax:
Practice Address - Street 1:2590 HEALING WAY
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33543-5495
Practice Address - Country:US
Practice Address - Phone:813-333-1186
Practice Address - Fax:844-691-5928
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11009053363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily