Healthcare Provider Details

I. General information

NPI: 1942592191
Provider Name (Legal Business Name): MAGGIE BOWERS ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

611 E ADAMS ST
JACKSONVILLE FL
32202-2847
US

IV. Provider business mailing address

611 E ADAMS ST
JACKSONVILLE FL
32202-2847
US

V. Phone/Fax

Practice location:
  • Phone: 904-394-8056
  • Fax: 904-359-0926
Mailing address:
  • Phone: 904-394-8056
  • Fax: 904-359-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LC1500X
TaxonomyCommunity Health Nurse Practitioner
License NumberPA9105122
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: