MEDICARE: CHRISTINA NICOLE LEWIS

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	174H00000X	Health Educator		FL

General Provider Information

NPI Number	:	1922618842
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTINA NICOLE LEWIS

Provider Business Mailing Address
First Line	:	12724 GRAN BAY PKWY W STE 150
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-9486
Country	:	US
Telephone Number	:	866-713-1180
Fax Number	:

Provider Business Practice Location Address
First Line	:	3737 SAINT JOHNS BLUFF RD S APT 1514
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-2608
Country	:	US
Telephone Number	:	904-562-6306
Fax Number	:

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

Provider Enumeration Date	:	08/05/2020
Last Update Date	:	08/05/2020

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