MEDICARE: GAIL MARIE FOWLER PAC

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	363A00000X	Physician Assistant	PA9106446	FL
2	363A00000X	Physician Assistant	000571	CT

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598750374
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GAIL MARIE FOWLER PAC

Provider Business Mailing Address
First Line	:	4651 VAN DYKE RD
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-4880
Country	:	US
Telephone Number	:	813-321-1786
Fax Number	:	813-321-1787

Provider Business Practice Location Address
First Line	:	2001 SIESTA DR STE 201
Second Line	:
City	:	SARASOTA
State	:	FL
Zip	:	34239-5200
Country	:	US
Telephone Number	:	813-321-1786
Fax Number	:	813-321-1787

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

Provider Enumeration Date	:	09/16/2005
Last Update Date	:	04/27/2023

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Directions to “ GAIL MARIE FOWLER PAC” Practice Location

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