Provider Demographics
NPI:1114515723
Name:COWART, CAMI MILLICENT (APRN)
Entity Type:Individual
Prefix:MRS
First Name:CAMI
Middle Name:MILLICENT
Last Name:COWART
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15260 NW 147TH DR STE 100
Mailing Address - Street 2:
Mailing Address - City:ALACHUA
Mailing Address - State:FL
Mailing Address - Zip Code:32615-5339
Mailing Address - Country:US
Mailing Address - Phone:386-418-1222
Mailing Address - Fax:
Practice Address - Street 1:15260 NW 147TH DR STE 100
Practice Address - Street 2:
Practice Address - City:ALACHUA
Practice Address - State:FL
Practice Address - Zip Code:32615-5339
Practice Address - Country:US
Practice Address - Phone:386-418-1222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-08
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11010675363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner