Provider Demographics
NPI:1336207372
Name:QUARLES, LACEY C (CRNP)
Entity Type:Individual
Prefix:MR
First Name:LACEY
Middle Name:C
Last Name:QUARLES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 RICE MINE ROAD LOOP
Mailing Address - Street 2:SUITE 206
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35406-2414
Mailing Address - Country:US
Mailing Address - Phone:205-339-0171
Mailing Address - Fax:205-333-8681
Practice Address - Street 1:100 RICE MINE ROAD LOOP
Practice Address - Street 2:SUITE 206
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35406-2414
Practice Address - Country:US
Practice Address - Phone:205-339-0171
Practice Address - Fax:205-333-8681
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-076828363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL891008370Medicaid
AL891008370Medicaid
ALP73377Medicare UPIN
AL1104250001Medicare NSC