Provider Demographics
NPI:1811999378
Name:LEWIS, SARA ANN (APRN)
Entity type:Individual
Prefix:DR
First Name:SARA
Middle Name:ANN
Last Name:LEWIS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2646 DANFORTH TER
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3433
Mailing Address - Country:US
Mailing Address - Phone:561-303-0433
Mailing Address - Fax:561-303-0433
Practice Address - Street 1:12200 FOREST HILL BLVD
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-5795
Practice Address - Country:US
Practice Address - Phone:561-303-0433
Practice Address - Fax:561-303-0433
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2019-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 2026462208000000X
FL2026462363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL303558100Medicaid