Individual
BETH NICHOLE JORDAN-LEWIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA, AGACNP-BC
Contact information
Practice address
980 MILWAUKEE AVE, DUNEDIN, FL 34698-7072
(727) 733-4610
Mailing address
5380 TECH DATA DR STE 101, CLEARWATER, FL 33760-3122
(727) 431-7241
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
RN091777
TN
363LA2100X
Acute Care Nurse Practitioner
APN11845
TN
363LA2100X
Acute Care Nurse Practitioner
APRN9467487
FL
363LG0600X
Gerontology Nurse Practitioner
APN11845
TN
363LG0600X
Gerontology Nurse Practitioner
APRN9467487
FL
367500000X
Certified Registered Nurse Anesthetist
APN11845
TN
367500000X
Certified Registered Nurse Anesthetist
Primary
APRN9467487
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3636462
—
TN
01
—
4117686
BLUE CROSS BLUE SHIELD TN
TN
01
—
P00441410
RAILROAD MEDICARE
TN
Enumeration date
12/04/2006
Last updated
07/21/2022
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