Individual
HEATHER LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
6310 HEALTH PARK WAY STE 200, LAKEWOOD RANCH, FL 34202-5177
(941) 907-4737
(941) 907-9493
Mailing address
4371 VERONICA S SHOEMAKER BLVD, FORT MYERS, FL 33916-2216
(239) 274-8200
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA112700
FL
Other
Enumeration date
11/22/2019
Last updated
11/22/2019
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