Healthcare Provider Details

I. General information

NPI: 1013741354
Provider Name (Legal Business Name): JANET I LEWIS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 WOODBINE RD STE C
PACE FL
32571-8791
US

IV. Provider business mailing address

PO BOX 6034
PENSACOLA FL
32503-0034
US

V. Phone/Fax

Practice location:
  • Phone: 850-384-3151
  • Fax: 850-994-9130
Mailing address:
  • Phone: 850-384-3151
  • Fax: 850-994-9130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JANET I LEWIS
Title or Position: PRESIDENT
Credential: MD
Phone: 850-384-3151