Individual
ERICKA NICOLE LEWIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
812 16TH AVE SE, RUSKIN, FL 33570-6013
(813) 476-8343
Mailing address
812 16TH AVE SE, RUSKIN, FL 33570-6013
(813) 476-8343
Taxonomy
Speciality
Code
Description
License number
State
261QD1600X
Developmental Disabilities Clinic/Center
Primary
236831
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
833874018
—
FL
Enumeration date
09/07/2022
Last updated
09/07/2022
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