1639119829 NPI number — MRS. MARY JOSEPHINE LIPANA-LEWIS ARNP

Table of content: MRS. MARY JOSEPHINE LIPANA-LEWIS ARNP (NPI 1639119829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639119829 NPI number — MRS. MARY JOSEPHINE LIPANA-LEWIS ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIPANA-LEWIS
Provider First Name:
MARY
Provider Middle Name:
JOSEPHINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LIPANA-LEWIS
Provider Other First Name:
MARY
Provider Other Middle Name:
JOY
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
ARNP
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1639119829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2646 TIMACQUA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOLIDAY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34691-8745
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-938-8034
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6352 RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34652-2241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-844-3551
Provider Business Practice Location Address Fax Number:
727-847-0427
Provider Enumeration Date:
06/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  RN 3078372 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 306769600 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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