Provider Demographics
NPI:1235262460
Name:LEWIS, NATALIE A (ARNP)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:A
Last Name:LEWIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:NATALIE
Other - Middle Name:A
Other - Last Name:LEWIS-DICAPUA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ARNP
Mailing Address - Street 1:250 SW 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33486-4405
Mailing Address - Country:US
Mailing Address - Phone:561-368-5063
Mailing Address - Fax:954-318-6599
Practice Address - Street 1:250 SW 15TH AVE
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33486-4405
Practice Address - Country:US
Practice Address - Phone:561-368-5063
Practice Address - Fax:954-318-6599
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1232332363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLARNP1232332OtherMEDICAL LIC #
FLARNP1232332OtherMEDICAL LIC #
FLU3009Medicare ID - Type UnspecifiedMEDICARE ID #