Provider Demographics
NPI:1063008035
Name:OWENS, RAYMOND P (RN)
Entity Type:Individual
Prefix:MR
First Name:RAYMOND
Middle Name:P
Last Name:OWENS
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1523 MEADOWBROOK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33803-2530
Mailing Address - Country:US
Mailing Address - Phone:863-738-0062
Mailing Address - Fax:
Practice Address - Street 1:1523 MEADOWBROOK AVE
Practice Address - Street 2:
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33803-2530
Practice Address - Country:US
Practice Address - Phone:863-738-0062
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3299932163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse