Individual
MR. ANTWAN EDWARD LACY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
FNP-C
Contact information
Practice address
7000 4TH ST N STE A, SAINT PETERSBURG, FL 33702-5903
(727) 526-3627
(727) 525-3492
Mailing address
7000 4TH ST N STE A, SAINT PETERSBURG, FL 33702-5903
(727) 526-3627
(727) 525-3492
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
9372952
FL
Other
Enumeration date
04/01/2018
Last updated
07/27/2021
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