MEDICARE: JAZMA LEWIS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1275949059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAZMA LEWIS

Provider Business Mailing Address
First Line	:	5578 ARNOLD PALMER DR
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32811-2475
Country	:	US
Telephone Number	:	904-403-5579
Fax Number	:

Provider Business Practice Location Address
First Line	:	6150 METROWEST BLVD STE 103
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3290
Country	:	US
Telephone Number	:	904-403-5579
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	07/01/2014

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