Healthcare Provider Details

I. General information

NPI: 1245169721
Provider Name (Legal Business Name): STEVEN J FOWLER
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2026
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3908 WOODGLADE CV
WINTER PARK FL
32792-6317
US

IV. Provider business mailing address

3908 WOODGLADE CV
WINTER PARK FL
32792-6317
US

V. Phone/Fax

Practice location:
  • Phone: 352-460-5957
  • Fax:
Mailing address:
  • Phone: 352-460-5957
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number158703
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: