Healthcare Provider Details

I. General information

NPI: 1164092755
Provider Name (Legal Business Name): BRANDI LEE BOWERS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2021
Last Update Date: 11/16/2023
Certification Date: 11/16/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4290 NW 1ST COURT RD
OCALA FL
34475-8757
US

IV. Provider business mailing address

4290 NW 1ST COURT RD
OCALA FL
34475-8757
US

V. Phone/Fax

Practice location:
  • Phone: 352-454-2304
  • Fax:
Mailing address:
  • Phone: 352-454-2304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN11013873
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: