Healthcare Provider Details

I. General information

NPI: 1669072328
Provider Name (Legal Business Name): IRMARITA LEWIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: RITA LEWIS

II. Dates (important events)

Enumeration Date: 10/30/2020
Last Update Date: 09/03/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2420 E OLIVE RD STE C
PENSACOLA FL
32514-5110
US

IV. Provider business mailing address

1250 OLIVER RD # 1116
FAIRFIELD CA
94534-3467
US

V. Phone/Fax

Practice location:
  • Phone: 850-299-9986
  • Fax:
Mailing address:
  • Phone: 707-470-2888
  • Fax: 866-626-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95016414
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number1189995
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number864848
License Number StateNV
# 5
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number831617
License Number StateCA
# 6
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberL1-0075241
License Number StateDE
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number13339946-4405
License Number StateUT
# 8
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberTPAN1731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: