MEDICARE: SARA BOWMAN LPN

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	251E00000X	Home Health Agency	5211408	FL

General Provider Information

NPI Number	:	1750742680
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARA BOWMAN LPN

Provider Business Mailing Address
First Line	:	PO BOX 16011
Second Line	:
City	:	CLEARWATER
State	:	FL
Zip	:	33766-6011
Country	:	US
Telephone Number	:	727-307-0345
Fax Number	:	727-674-2932

Provider Business Practice Location Address
First Line	:	4374 RIDGEMOOR DR
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34685-1165
Country	:	US
Telephone Number	:	727-831-8395
Fax Number	:

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

Provider Enumeration Date	:	03/21/2016
Last Update Date	:	03/21/2016

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