Healthcare Provider Details

I. General information

NPI: 1639717705
Provider Name (Legal Business Name): SUSAN MARIE BOWLES DNP,APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2019
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

83 W MILLER ST
ORLANDO FL
32806-2031
US

IV. Provider business mailing address

8009 GLASTONBURY PL
MELBOURNE FL
32940-2141
US

V. Phone/Fax

Practice location:
  • Phone: 321-843-3433
  • Fax:
Mailing address:
  • Phone: 321-525-6507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License NumberAPRN-9373689
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: