Healthcare Provider Details

I. General information

NPI: 1063707933
Provider Name (Legal Business Name): KOUJI J. BOWSER CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2011
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

2500 HARBOR BLVD
PORT CHARLOTTE FL
33952-5000
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-6438
  • Fax: 352-273-8612
Mailing address:
  • Phone: 941-766-4125
  • Fax: 941-766-4101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9228400
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: