Healthcare Provider Details

I. General information

NPI: 1841251600
Provider Name (Legal Business Name): TRACEY HUSNANDER BOWSMAN RN, CDE
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3441 SE WILLOUGHBY BLVD
STUART FL
34994-5060
US

IV. Provider business mailing address

4387 SW LA PALOMA DR
PALM CITY FL
34990-7949
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-4030
  • Fax:
Mailing address:
  • Phone: 772-287-7968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN3191892
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: