MEDICARE: MS. TIA NICOLE BOWDEN ARNP

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
1	363LG0600X	Gerontology Nurse Practitioner	ARNP9267676	FL

General Provider Information

NPI Number	:	1831567908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. TIA NICOLE BOWDEN ARNP

Provider Business Mailing Address
First Line	:	1010 NE 8TH AVE
Second Line	:	#20 D
City	:	DELRAY BEACH
State	:	FL
Zip	:	33483-5853
Country	:	US
Telephone Number	:	561-702-6625
Fax Number	:	561-278-4628

Provider Business Practice Location Address
First Line	:	2015 OCEAN DR STE 11
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33426-5131
Country	:	US
Telephone Number	:	561-364-8056
Fax Number	:	561-364-8507

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/08/2015
Last Update Date	:	02/28/2023

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