Provider Demographics
NPI:1003467275
Name:LEWIS, YANIQUE LATOYA (FNP-C)
Entity Type:Individual
Prefix:
First Name:YANIQUE
Middle Name:LATOYA
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1467 JOHN ROBERT DR STE B
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-1770
Mailing Address - Country:US
Mailing Address - Phone:770-293-8050
Mailing Address - Fax:
Practice Address - Street 1:1467 JOHN ROBERT DR STE B
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-1770
Practice Address - Country:US
Practice Address - Phone:770-293-8050
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-27
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN248450363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily