Provider Demographics
NPI:1215737556
Name:LEWIS, CHARNISHA LAVERN (MSW, RCSWI)
Entity type:Individual
Prefix:MRS
First Name:CHARNISHA
Middle Name:LAVERN
Last Name:LEWIS
Suffix:
Gender:
Credentials:MSW, RCSWI
Other - Prefix:MS
Other - First Name:CHARNISHA
Other - Middle Name:LAVERN
Other - Last Name:PALMORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:4906 WILD COFFEE AVE
Mailing Address - Street 2:
Mailing Address - City:WIMAUMA
Mailing Address - State:FL
Mailing Address - Zip Code:33598-2410
Mailing Address - Country:US
Mailing Address - Phone:904-874-2800
Mailing Address - Fax:
Practice Address - Street 1:4906 WILD COFFEE AVE
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-2410
Practice Address - Country:US
Practice Address - Phone:904-874-2800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-17
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL00000208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist