Provider Demographics
NPI:1669142527
Name:LEWIS, ANGELO JUNARD (APRN)
Entity type:Individual
Prefix:MR
First Name:ANGELO
Middle Name:JUNARD
Last Name:LEWIS
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1717 S ORANGE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2946
Mailing Address - Country:US
Mailing Address - Phone:321-841-4344
Mailing Address - Fax:321-843-1753
Practice Address - Street 1:1717 S ORANGE AVE STE 103
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-2946
Practice Address - Country:US
Practice Address - Phone:321-841-4344
Practice Address - Fax:321-843-1753
Is Sole Proprietor?:No
Enumeration Date:2021-09-14
Last Update Date:2025-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FL11014189363L00000X
FLAPRN11014189363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner