MEDICARE: CAROL VIRGINIA LEWIS ARNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LA2200X	Adult Health Nurse Practitioner	ARNP 1087932	FL
2	363LF0000X	Family Nurse Practitioner	APRN1087932	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578591830
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL VIRGINIA LEWIS ARNP

Provider Business Mailing Address
First Line	:	6900 TAVISTOCK LAKES BLVD STE 300
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32827-7592
Country	:	US
Telephone Number	:	833-309-3737
Fax Number	:	321-380-1411

Provider Business Practice Location Address
First Line	:	8614 STATE ROAD 70 E STE 200
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34202-3710
Country	:	US
Telephone Number	:	941-727-1243
Fax Number	:	941-751-9039

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	01/02/2024

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