Healthcare Provider Details

I. General information

NPI: 1255308474
Provider Name (Legal Business Name): CAROL S LEWIS PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 03/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12271 US HIGHWAY 301 N 301
PARRISH FL
34219-8410
US

IV. Provider business mailing address

PO BOX 499
PARRISH FL
34219-0499
US

V. Phone/Fax

Practice location:
  • Phone: 941-776-4000
  • Fax: 941-776-4010
Mailing address:
  • Phone: 941-776-4000
  • Fax: 941-776-4010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2303
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9104822
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: