Provider Demographics
NPI:1619436771
Name:LEWIS, JOHN CORBRIDGE (APRN-RNP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:CORBRIDGE
Last Name:LEWIS
Suffix:
Gender:M
Credentials:APRN-RNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2730 E WALNUT DR
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:AZ
Mailing Address - Zip Code:85939-2658
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1876 E SABIN DR
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-6197
Practice Address - Country:US
Practice Address - Phone:520-836-9800
Practice Address - Fax:520-836-1510
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2023-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ219712363LA2200X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health