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General NPI Number Information
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NPI Number | 1659336634
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Entity Type | Individual
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Provider Name | MICHELLE LEWIS PMHNP
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Gender | Female
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 05/11/2025
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Provider Practice Location Address
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Address Line | 2015 GRANT PL
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City | MELBOURNE
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State | FL
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Zip | 32901-5600
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Country | US
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Telephone | 772-492-6394
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Fax | 709-400-7957
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Provider Business Mailing Address
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Address Line | 255 DRYDEN CIR
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City | COCOA
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State | FL
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Zip | 32926-2481
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Country | US
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Telephone | 321-536-9089
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Fax | 321-978-9280
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | ARNP2874472
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2874472
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License Number State | FL
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