Provider Demographics
NPI:1245781509
Name:LEWIS, LAURA LIESELOTTE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:LAURA
Middle Name:LIESELOTTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:PA-C
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Mailing Address - Street 1:2501 NORTH ORANGE AVENUE
Mailing Address - Street 2:SUITE 240
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804
Mailing Address - Country:US
Mailing Address - Phone:407-303-2615
Mailing Address - Fax:407-303-5193
Practice Address - Street 1:2501 NORTH ORANGE AVENUE
Practice Address - Street 2:SUITE 240
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804
Practice Address - Country:US
Practice Address - Phone:407-303-2615
Practice Address - Fax:407-303-5193
Is Sole Proprietor?:No
Enumeration Date:2016-10-20
Last Update Date:2016-12-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPA9109951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant