Healthcare Provider Details

I. General information

NPI: 1497909451
Provider Name (Legal Business Name): TAMARA STOWERS CROWELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 01/03/2022
Certification Date: 01/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11513 N MAIN ST
JACKSONVILLE FL
32218-4002
US

IV. Provider business mailing address

2675 WINKLER AVE FL 2
FORT MYERS FL
33901-9342
US

V. Phone/Fax

Practice location:
  • Phone: 904-751-6200
  • Fax: 904-751-1600
Mailing address:
  • Phone: 877-856-3774
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9101017
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: