Provider Demographics
NPI:1578294708
Name:BAHR, LACEY MCCARTHY (APRN)
Entity Type:Individual
Prefix:
First Name:LACEY
Middle Name:MCCARTHY
Last Name:BAHR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:LACEY
Other - Middle Name:D
Other - Last Name:MCCARTHY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38135 MARKET SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33542-7539
Mailing Address - Country:US
Mailing Address - Phone:813-751-3636
Mailing Address - Fax:813-377-1678
Practice Address - Street 1:2100 VIA BELLA BLVD STE 204
Practice Address - Street 2:
Practice Address - City:LAND O LAKES
Practice Address - State:FL
Practice Address - Zip Code:34639-5429
Practice Address - Country:US
Practice Address - Phone:813-751-3636
Practice Address - Fax:813-377-1678
Is Sole Proprietor?:No
Enumeration Date:2022-06-20
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11020171363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily