=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811879331
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CASSANDRA BOWMAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/24/2025
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 501 6TH AVE S
-----------------------------------------------------
City | ST PETERSBURG
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33701-4634
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-898-7451
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5135 CAMERON FOREST PKWY
-----------------------------------------------------
City | JOHNS CREEK
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 30022-4595
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 678-687-1989
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WN0002X
-----------------------------------------------------
Taxonomy Name | Neonatal Intensive Care Registered Nurse
-----------------------------------------------------
License Number | RN297151
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------