Healthcare Provider Details

I. General information

NPI: 1003924119
Provider Name (Legal Business Name): AMY L LEWIS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8927 US HIGHWAY 301 N STE 210
PARRISH FL
34219-8701
US

IV. Provider business mailing address

3018 53RD AVE E
BRADENTON FL
34203-4331
US

V. Phone/Fax

Practice location:
  • Phone: 941-845-4621
  • Fax:
Mailing address:
  • Phone: 941-348-2760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1240-023
License Number StateZZ
# 3
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3618-024
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9115041
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: