Individual
MRS. LACIE TARA MADISON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
5151 N 9TH AVE, PENSACOLA, FL 32504-8721
(850) 416-7000
Mailing address
26487 US HIGHWAY 98, ELBERTA, AL 36530-2709
(251) 752-7206
Taxonomy
Speciality
Code
Description
License number
State
207PP0204X
Pediatric Emergency Medicine (Emergency Medicine) Physician
Primary
9463502
FL
363LF0000X
Family Nurse Practitioner
ARNP9463502
FL
Other
Enumeration date
04/21/2009
Last updated
04/17/2024
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