Provider Demographics
NPI:1083152466
Name:UPPOLE, LACIE A (APRN)
Entity Type:Individual
Prefix:MS
First Name:LACIE
Middle Name:A
Last Name:UPPOLE
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LACIE
Other - Middle Name:A
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16106 MARSH RD
Mailing Address - Street 2:
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-9182
Mailing Address - Country:US
Mailing Address - Phone:407-347-0600
Mailing Address - Fax:407-296-1549
Practice Address - Street 1:16106 MARSH RD STE 102
Practice Address - Street 2:
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-9182
Practice Address - Country:US
Practice Address - Phone:407-635-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-06
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN9328029363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health