MEDICARE: JACLYN MICHELLE BOWDEN APRN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APRN11003657	FL
2	363L00000X	Nurse Practitioner	APRN11003657	FL

General Provider Information

NPI Number	:	1508411190
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACLYN MICHELLE BOWDEN APRN

Provider Business Mailing Address
First Line	:	PO BOX 43667
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32203-3667
Country	:	US
Telephone Number	:	904-720-0599
Fax Number	:	904-376-4036

Provider Business Practice Location Address
First Line	:	6930 BONNEVAL RD STE 2
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32216-6084
Country	:	US
Telephone Number	:	904-854-6899
Fax Number	:	904-338-0533

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2019
Last Update Date	:	12/18/2019

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