Healthcare Provider Details

I. General information

NPI: 1295270619
Provider Name (Legal Business Name): ABBY FOWLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ABBY FOWLER PA

II. Dates (important events)

Enumeration Date: 12/20/2016
Last Update Date: 03/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 MOBILE HWY
PENSACOLA FL
32506-3229
US

IV. Provider business mailing address

PO BOX 2619
PENSACOLA FL
32513-2699
US

V. Phone/Fax

Practice location:
  • Phone: 850-453-3281
  • Fax: 850-453-4491
Mailing address:
  • Phone: 850-475-4500
  • Fax: 850-475-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA9109896
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: