Provider Demographics
NPI:1891783171
Name:LEWIN, HEATHER G (ARNP)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:G
Last Name:LEWIN
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4371 VERONICA S. SHOEMAKER BLVD.
Mailing Address - Street 2:ATTN: CREDENTIALING
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-2216
Mailing Address - Country:US
Mailing Address - Phone:239-274-8200
Mailing Address - Fax:239-278-3350
Practice Address - Street 1:720 SW 2ND AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32601-1209
Practice Address - Country:US
Practice Address - Phone:352-373-0933
Practice Address - Fax:352-377-5215
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-11
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3286122363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL500027613OtherRAILROAD MEDICARE
FL303845900Medicaid
FL500027613OtherRAILROAD MEDICARE
FLY0084Medicare ID - Type Unspecified