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General NPI Number Information
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NPI Number | 1639880800
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Entity Type | Individual
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Provider Name | GRACE ELIZABETH COWAN APRN, AANP-BC
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Gender | Female
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Dates
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Enumeration Date | 12/08/2022
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Last Update Date | 02/23/2024
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Provider Practice Location Address
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Address Line | 2631 E OAKLAND PARK BLVD STE 110
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City | FORT LAUDERDALE
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State | FL
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Zip | 33306-1607
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Country | US
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Telephone | 954-514-7306
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Fax |
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Provider Business Mailing Address
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Address Line | 9 HENDRICKS ISLE
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City | FORT LAUDERDALE
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State | FL
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Zip | 33301-3702
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Country | US
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Telephone | 614-246-1129
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 11022619
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License Number State | FL
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