Healthcare Provider Details

I. General information

NPI: 1891556072
Provider Name (Legal Business Name): YASHIEVA LEWIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2024
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3630 MONARCH BREEZE DR APT 103
RIVERVIEW FL
33578-5479
US

IV. Provider business mailing address

PO BOX 516
MANGO FL
33550-0516
US

V. Phone/Fax

Practice location:
  • Phone: 813-580-9849
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: