=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245254119
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | SUSAN AILEEN LEWIS ARNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10000 BAY PINES BLVD
-----------------------------------------------------
City | ST. PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33708
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-398-6661
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 12188 BONNIE TER SEMINOLE, FLORIDA
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33772-3423
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-391-3797
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LA2200X
-----------------------------------------------------
Taxonomy Name | Adult Health Nurse Practitioner
-----------------------------------------------------
License Number | ARNP 1829672
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------