Provider Demographics
NPI:1285034785
Name:OWENS, NOSAGHARE
Entity Type:Individual
Prefix:
First Name:NOSAGHARE
Middle Name:
Last Name:OWENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1621
Mailing Address - Street 2:
Mailing Address - City:RUSKIN
Mailing Address - State:FL
Mailing Address - Zip Code:33575-1621
Mailing Address - Country:US
Mailing Address - Phone:813-294-5510
Mailing Address - Fax:813-320-0991
Practice Address - Street 1:1417 TAHOE SPRINGS CT
Practice Address - Street 2:
Practice Address - City:RUSKIN
Practice Address - State:FL
Practice Address - Zip Code:33570-2015
Practice Address - Country:US
Practice Address - Phone:813-294-5510
Practice Address - Fax:813-320-0991
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-03
Last Update Date:2015-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
104100000X
FLW137977302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker