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General NPI Number Information
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NPI Number | 1376601351
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Entity Type | Individual
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Provider Name | BETH NICHOLE JORDAN-LEWIS CRNA, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/04/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 980 MILWAUKEE AVE
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City | DUNEDIN
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State | FL
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Zip | 34698-7072
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Country | US
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Telephone | 727-733-4610
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Fax |
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Provider Business Mailing Address
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Address Line | 5380 TECH DATA DR STE 101
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City | CLEARWATER
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State | FL
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Zip | 33760-3122
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Country | US
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Telephone | 727-431-7241
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN091777
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APN11845
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | APRN9467487
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License Number State | FL
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Taxonomy #4
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APRN9467487
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License Number State | FL
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Taxonomy #5
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | APN11845
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License Number State | TN
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Taxonomy #6
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APN11845
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License Number State | TN
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Taxonomy #7
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN9467487
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License Number State | FL
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