Provider Demographics
NPI:1699008482
Name:LACY-TAYLOR, ROSALAND ROCHELLE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:ROSALAND
Middle Name:ROCHELLE
Last Name:LACY-TAYLOR
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23736 HIGHWAY 59
Mailing Address - Street 2:STE. 104
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-4634
Mailing Address - Country:US
Mailing Address - Phone:281-354-1133
Mailing Address - Fax:
Practice Address - Street 1:23736 HIGHWAY 59
Practice Address - Street 2:STE. 104
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-4634
Practice Address - Country:US
Practice Address - Phone:281-354-1133
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-10
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP117065363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily