Healthcare Provider Details

I. General information

NPI: 1932950870
Provider Name (Legal Business Name): KOURTNI LEWIS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2024
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15212 E COLONIAL DR
ORLANDO FL
32826-5518
US

IV. Provider business mailing address

15212 E COLONIAL DR
ORLANDO FL
32826-5518
US

V. Phone/Fax

Practice location:
  • Phone: 407-380-1777
  • Fax: 407-380-1766
Mailing address:
  • Phone: 407-380-1777
  • Fax: 407-380-1766

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number11032063
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: