Provider Demographics
NPI:1730633660
Name:LEWIS, TASHANECA SHONTE (FNP-BC)
Entity type:Individual
Prefix:MISS
First Name:TASHANECA
Middle Name:SHONTE
Last Name:LEWIS
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3622 GREENWICH AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-6331
Mailing Address - Country:US
Mailing Address - Phone:404-277-7286
Mailing Address - Fax:
Practice Address - Street 1:2805 HAMILTON MILL RD
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4110
Practice Address - Country:US
Practice Address - Phone:678-541-0588
Practice Address - Fax:678-541-0610
Is Sole Proprietor?:No
Enumeration Date:2016-08-09
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN195801363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily