Provider Demographics
NPI:1366816555
Name:LEWIS, JACLYN ANN (NP)
Entity Type:Individual
Prefix:
First Name:JACLYN
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JACLYN
Other - Middle Name:ANN
Other - Last Name:STARKE LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NP
Mailing Address - Street 1:49 FALLON AVE
Mailing Address - Street 2:
Mailing Address - City:SEAFORD
Mailing Address - State:DE
Mailing Address - Zip Code:19973-1577
Mailing Address - Country:US
Mailing Address - Phone:302-629-5030
Mailing Address - Fax:302-629-5035
Practice Address - Street 1:49 FALLON AVE
Practice Address - Street 2:
Practice Address - City:SEAFORD
Practice Address - State:DE
Practice Address - Zip Code:19973-1577
Practice Address - Country:US
Practice Address - Phone:302-629-5030
Practice Address - Fax:302-629-5035
Is Sole Proprietor?:No
Enumeration Date:2015-11-25
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG-0000891363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner