Basic Information
| Provider Information | |||||||||
| NPI: | 1578294708 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAHR | ||||||||
| FirstName: | LACEY | ||||||||
| MiddleName: | MCCARTHY | ||||||||
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| Credential: | APRN | ||||||||
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| OtherLastName: | MCCARTHY | ||||||||
| OtherFirstName: | LACEY | ||||||||
| OtherMiddleName: | D | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 38135 MARKET SQUARE DR | ||||||||
| Address2: | |||||||||
| City: | ZEPHYRHILLS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335427539 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137513636 | ||||||||
| FaxNumber: | 8133771678 | ||||||||
| Practice Location | |||||||||
| Address1: | 2100 VIA BELLA BLVD STE 204 | ||||||||
| Address2: | |||||||||
| City: | LAND O LAKES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346395429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137513636 | ||||||||
| FaxNumber: | 8133771678 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2022 | ||||||||
| LastUpdateDate: | 06/20/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/20/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | APRN11020171 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.