Healthcare Provider Details

I. General information

NPI: 1003408253
Provider Name (Legal Business Name): MRS. PEARL OWUSU-BUGYEI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/09/2021
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

707 DRUID RD E
CLEARWATER FL
33756-3913
US

IV. Provider business mailing address

14100 58TH ST N
CLEARWATER FL
33760-9900
US

V. Phone/Fax

Practice location:
  • Phone: 727-824-8181
  • Fax:
Mailing address:
  • Phone: 727-824-8181
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number11011560
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: