Individual
REGINA LACY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
4729 39TH AVE N APT 108, ST PETERSBURG, FL 33714-3461
(229) 375-8325
Mailing address
PO BOX 55968, SAINT PETERSBURG, FL 33732-5968
Taxonomy
Speciality
Code
Description
License number
State
253Z00000X
In Home Supportive Care Agency
Primary
—
—
Other
Enumeration date
03/11/2020
Last updated
03/11/2020
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