Provider Demographics
NPI:1508411760
Name:BOWMAN, JOSEPH BONIFACE (FNP-C)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:BONIFACE
Last Name:BOWMAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3373 GLEN EDEN QUAY
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-6241
Mailing Address - Country:US
Mailing Address - Phone:757-618-5134
Mailing Address - Fax:
Practice Address - Street 1:3373 GLEN EDEN QUAY
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-6241
Practice Address - Country:US
Practice Address - Phone:757-618-5134
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2019-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024177991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily