Basic Information
| Provider Information | |||||||||
| NPI: | 1215395033 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEWIS | ||||||||
| FirstName: | SHAMIRA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3717 TURMAN LOOP | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335447794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134020238 | ||||||||
| FaxNumber: | 8139075559 | ||||||||
| Practice Location | |||||||||
| Address1: | 3717 TURMAN LOOP | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | WESLEY CHAPEL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335447794 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134020238 | ||||||||
| FaxNumber: | 8139075559 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2016 | ||||||||
| LastUpdateDate: | 09/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 9281172 | FL | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | R2A4K | 01 | FL | BCBS | OTHER | P01655878 | 01 | FL | RAILROAD MEDICARE | OTHER | 016758300 | 05 | FL | MEDICAID |