Healthcare Provider Details

I. General information

NPI: 1588345763
Provider Name (Legal Business Name): M3J ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2023
Last Update Date: 05/11/2025
Certification Date: 05/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 DRYDEN CIRCLE
COCOA FL
32926
US

IV. Provider business mailing address

255 DRYDEN CIRCLE
COCOA FL
32926
US

V. Phone/Fax

Practice location:
  • Phone: 321-349-3442
  • Fax:
Mailing address:
  • Phone: 321-349-3442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MICHELLE A LEWIS
Title or Position: OWNER
Credential: PMHNP
Phone: 321-412-0577