Provider Demographics
NPI:1225420102
Name:LEWIS, CONSTANCE LYNN-ZEDAKER (ARNP)
Entity Type:Individual
Prefix:
First Name:CONSTANCE
Middle Name:LYNN-ZEDAKER
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2439 BEE RIDGE RD
Mailing Address - Street 2:2453 BEE RIDGE ROAD
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34239-6304
Mailing Address - Country:US
Mailing Address - Phone:941-365-5367
Mailing Address - Fax:941-955-0453
Practice Address - Street 1:2439 BEE RIDGE RD
Practice Address - Street 2:2453 BEE RIDGE RD
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34239-6304
Practice Address - Country:US
Practice Address - Phone:941-365-5367
Practice Address - Fax:941-955-0453
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2015-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9326466363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health