Healthcare Provider Details

I. General information

NPI: 1861767295
Provider Name (Legal Business Name): RYAN BOWER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2012
Last Update Date: 11/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 CREEKSIDE BLVD SUITE 1
NAPLES FL
34108-1931
US

IV. Provider business mailing address

3767 TRIPOLI BLVD
PUNTA GORDA FL
33950-7876
US

V. Phone/Fax

Practice location:
  • Phone: 239-261-1158
  • Fax:
Mailing address:
  • Phone: 352-494-1239
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAPRN9265011
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number89731
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: