Provider Demographics
NPI:1003924119
Name:LEWIS, AMY L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:L
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3018 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-4331
Mailing Address - Country:US
Mailing Address - Phone:941-348-2760
Mailing Address - Fax:
Practice Address - Street 1:8927 US HIGHWAY 301 N STE 210
Practice Address - Street 2:
Practice Address - City:PARRISH
Practice Address - State:FL
Practice Address - Zip Code:34219-8701
Practice Address - Country:US
Practice Address - Phone:941-845-4621
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-28
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
ZZ1240-023363A00000X
WI3618-024363A00000X
FL9115041363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant