Individual
LACEY DENNIS BRACKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS,LAT,ATC
Contact information
Practice address
1149 W 13TH ST, JACKSONVILLE, FL 32209-5610
(770) 778-1938
Mailing address
7491 MISHKIE DR, JACKSONVILLE, FL 32244-8157
(770) 778-1938
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
AL4863
FL
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
01/24/2017
Last updated
04/17/2020
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