Provider Demographics
NPI:1295230845
Name:CAWTHRON, LACEY (ARNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:LACEY
Middle Name:
Last Name:CAWTHRON
Suffix:
Gender:F
Credentials:ARNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 BENTIN DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32250-2779
Mailing Address - Country:US
Mailing Address - Phone:904-412-3152
Mailing Address - Fax:
Practice Address - Street 1:8130 BAYMEADOWS CIR W STE 109
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-1837
Practice Address - Country:US
Practice Address - Phone:844-808-9096
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9265995363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health