Provider Demographics
NPI:1417507625
Name:MILLS-BOWEN, ERICKA D
Entity Type:Individual
Prefix:
First Name:ERICKA
Middle Name:D
Last Name:MILLS-BOWEN
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 1:2414 INDIAN KEY DR
Mailing Address - Street 2:
Mailing Address - City:HOLIDAY
Mailing Address - State:FL
Mailing Address - Zip Code:34691-7813
Mailing Address - Country:US
Mailing Address - Phone:980-330-0749
Mailing Address - Fax:
Practice Address - Street 1:2414 INDIAN KEY DR
Practice Address - Street 2:
Practice Address - City:HOLIDAY
Practice Address - State:FL
Practice Address - Zip Code:34691-7813
Practice Address - Country:US
Practice Address - Phone:980-330-0749
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider