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NPI Code Detail

MEDICARE: KOUJI J. BOWSER CRNA

MEDICARE: KOUJI J. BOWSER CRNA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1367500000XCertified Registered Nurse AnesthetistAPRN9228400FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1G00SGOTHERFLBCBS
2XXX-XX-5407OTHERCHAMPUS / TRICARE SOUTH REGION
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063707933
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOUJI J. BOWSER CRNA
Provider Business Mailing Address
First Line : 2500 HARBOR BLVD
Second Line :
City : PORT CHARLOTTE
State : FL
Zip : 33952-5000
Country : US
Telephone Number : 941-766-4125
Fax Number : 941-766-4101
Provider Business Practice Location Address
First Line : 1600 SW ARCHER RD
Second Line :
City : GAINESVILLE
State : FL
Zip : 32610-3003
Country : US
Telephone Number : 352-273-6438
Fax Number : 352-273-8612
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/18/2011
Last Update Date : 06/01/2026

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