Healthcare Provider Details

I. General information

NPI: 1497593123
Provider Name (Legal Business Name): LORI LEE BOWE RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2024
Last Update Date: 07/17/2024
Certification Date: 07/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CHILD ST DEPT 5000
JACKSONVILLE FL
32214-5000
US

IV. Provider business mailing address

2930 SUNRISE CREEK RD
GREEN COVE SPRINGS FL
32043-8629
US

V. Phone/Fax

Practice location:
  • Phone: 904-542-9334
  • Fax:
Mailing address:
  • Phone: 252-269-8893
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN9420333
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: