MEDICARE: MS. GRACE ELIZABETH COWAN APRN, AANP-BC

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	363L00000X	Nurse Practitioner	11022619	FL

General Provider Information

NPI Number	:	1639880800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GRACE ELIZABETH COWAN APRN, AANP-BC

Provider Business Mailing Address
First Line	:	9 HENDRICKS ISLE
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-3702
Country	:	US
Telephone Number	:	614-246-1129
Fax Number	:

Provider Business Practice Location Address
First Line	:	2631 E OAKLAND PARK BLVD STE 110
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33306-1607
Country	:	US
Telephone Number	:	954-514-7306
Fax Number	:

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

Provider Enumeration Date	:	12/08/2022
Last Update Date	:	02/23/2024

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