Provider Demographics
NPI:1992025175
Name:LEMONIS, AMY MARIE (CO, LO, LPR)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:MARIE
Last Name:LEMONIS
Suffix:
Gender:F
Credentials:CO, LO, LPR
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:MARIE
Other - Last Name:MOUNTAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CO, LO, LPR
Mailing Address - Street 1:3660 CENTRAL AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33901-7699
Mailing Address - Country:US
Mailing Address - Phone:239-936-3736
Mailing Address - Fax:239-936-1171
Practice Address - Street 1:3660 CENTRAL AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33901-7699
Practice Address - Country:US
Practice Address - Phone:239-936-3736
Practice Address - Fax:239-936-1171
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2010-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLORT184174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLORT184OtherFLORIDA DEPARTMENT OF HEALTH