Provider Demographics
NPI:1518951227
Name:MOWRY, SHAWN ADAM (CRNA)
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:ADAM
Last Name:MOWRY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5182 SE 39TH LOOP
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-0633
Mailing Address - Country:US
Mailing Address - Phone:352-867-5290
Mailing Address - Fax:352-867-5290
Practice Address - Street 1:1431 SW 1ST AVE
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34474-4000
Practice Address - Country:US
Practice Address - Phone:352-401-1000
Practice Address - Fax:352-873-9726
Is Sole Proprietor?:No
Enumeration Date:2005-09-08
Last Update Date:2009-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP3291662367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP00669514OtherRR MEDICARE
FL305442000Medicaid
FL305442000Medicaid
FLP00669514OtherRR MEDICARE