Provider Demographics
NPI:1821536913
Name:LEWIS, MECHELLE LOUISE (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MECHELLE
Middle Name:LOUISE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:MECHELLE
Other - Middle Name:
Other - Last Name:WILLIAMS HUCALUK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:212 S. PINE AVENUE
Mailing Address - Street 2:
Mailing Address - City:INVERNESS
Mailing Address - State:FL
Mailing Address - Zip Code:34452
Mailing Address - Country:US
Mailing Address - Phone:352-419-6537
Mailing Address - Fax:352-419-6541
Practice Address - Street 1:212 S. PINE AVENUE
Practice Address - Street 2:
Practice Address - City:INVERNESS
Practice Address - State:FL
Practice Address - Zip Code:34452
Practice Address - Country:US
Practice Address - Phone:352-419-6537
Practice Address - Fax:352-419-6541
Is Sole Proprietor?:No
Enumeration Date:2017-02-08
Last Update Date:2019-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9479574363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner