Provider Demographics
NPI:1811172323
Name:LEWIS ANDERSON, LAVERN ANGELA (DNP)
Entity type:Individual
Prefix:DR
First Name:LAVERN
Middle Name:ANGELA
Last Name:LEWIS ANDERSON
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:LAVERN
Other - Middle Name:ANGELA
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DNP
Mailing Address - Street 1:1611 NW 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33136-1005
Mailing Address - Country:US
Mailing Address - Phone:305-585-7528
Mailing Address - Fax:
Practice Address - Street 1:1611 NW 12 AVENUE
Practice Address - Street 2:JACKSON MEMORIAL HOSPITAL
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33136-4615
Practice Address - Country:US
Practice Address - Phone:305-585-7528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-01-02
Last Update Date:2024-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9189456363L00000X
FLAPRN9189456363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner