Provider Demographics
NPI:1639119829
Name:LIPANA-LEWIS, MARY JOSEPHINE (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:JOSEPHINE
Last Name:LIPANA-LEWIS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:JOY
Other - Last Name:LIPANA-LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:ARNP
Mailing Address - Street 1:2646 TIMACQUA DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-8745
Mailing Address - Country:US
Mailing Address - Phone:727-938-8034
Mailing Address - Fax:
Practice Address - Street 1:6352 RIVER RD
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34652-2241
Practice Address - Country:US
Practice Address - Phone:727-844-3551
Practice Address - Fax:727-847-0427
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 3078372363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306769600Medicaid