Provider Demographics
NPI:1457451130
Name:KOWALSKI, JO ANNE THERESA (ARNP)
Entity Type:Individual
Prefix:
First Name:JO ANNE
Middle Name:THERESA
Last Name:KOWALSKI
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17050 CORAL CAY LN
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-5073
Mailing Address - Country:US
Mailing Address - Phone:239-851-2800
Mailing Address - Fax:239-466-1367
Practice Address - Street 1:17050 CORAL CAY LN
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-5073
Practice Address - Country:US
Practice Address - Phone:239-851-2800
Practice Address - Fax:239-466-1367
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL3224692363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP63058Medicare UPIN
E7725Medicare ID - Type Unspecified