MEDICARE: GINA MARIE LEWIS APRN, AGACNP-BC

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	363LA2100X	Acute Care Nurse Practitioner	11037797	FL

General Provider Information

NPI Number	:	1821894536
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GINA MARIE LEWIS APRN, AGACNP-BC

Provider Business Mailing Address
First Line	:	14326 SW SOLANGE ST
Second Line	:
City	:	PORT ST LUCIE
State	:	FL
Zip	:	34987-5845
Country	:	US
Telephone Number	:	631-624-5261
Fax Number	:

Provider Business Practice Location Address
First Line	:	1900 NEBRASKA AVE STE 9
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4837
Country	:	US
Telephone Number	:	772-465-4499
Fax Number	:

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

Provider Enumeration Date	:	02/22/2025
Last Update Date	:	05/26/2026

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