Healthcare Provider Details

I. General information

NPI: 1407021173
Provider Name (Legal Business Name): JACQUELINE Q SOSA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JACQUELINE Q BOWERS M.D.

II. Dates (important events)

Enumeration Date: 04/24/2008
Last Update Date: 05/13/2022
Certification Date: 05/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5950 S FLORIDA AVE
LAKELAND FL
33813-2532
US

IV. Provider business mailing address

5950 S FLORIDA AVE
LAKELAND FL
33813-2532
US

V. Phone/Fax

Practice location:
  • Phone: 863-688-3550
  • Fax: 863-687-8969
Mailing address:
  • Phone: 863-688-3550
  • Fax: 863-687-8969

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number2019-02593
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME155925
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: