Provider Demographics
NPI:1922592161
Name:LEWIS, ZOE
Entity Type:Individual
Prefix:
First Name:ZOE
Middle Name:
Last Name:LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 NW 69TH AVE
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-5664
Mailing Address - Country:US
Mailing Address - Phone:954-829-4596
Mailing Address - Fax:
Practice Address - Street 1:6100 NW 69TH AVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-5664
Practice Address - Country:US
Practice Address - Phone:954-829-4596
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-20
Last Update Date:2024-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
FL202309233374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician