Provider Demographics
NPI:1225928393
Name:SANTA CRUZ, LACEY B (CRNP)
Entity type:Individual
Prefix:
First Name:LACEY
Middle Name:B
Last Name:SANTA CRUZ
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:PO BOX 519
Mailing Address - Street 2:
Mailing Address - City:ELBERTA
Mailing Address - State:AL
Mailing Address - Zip Code:36530-0519
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:24980 STATE ST
Practice Address - Street 2:
Practice Address - City:ELBERTA
Practice Address - State:AL
Practice Address - Zip Code:36530-2573
Practice Address - Country:US
Practice Address - Phone:251-986-7301
Practice Address - Fax:251-986-5927
Is Sole Proprietor?:No
Enumeration Date:2025-07-08
Last Update Date:2025-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-182581363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily