Provider Demographics
NPI:1629440516
Name:BOWEN, TYESHA (AGNP)
Entity Type:Individual
Prefix:MISS
First Name:TYESHA
Middle Name:
Last Name:BOWEN
Suffix:
Gender:F
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:276 KENSINGTON WAY
Mailing Address - Street 2:
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33414-4316
Mailing Address - Country:US
Mailing Address - Phone:561-412-8992
Mailing Address - Fax:401-238-6057
Practice Address - Street 1:1691 FORUM PL STE B
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401-2336
Practice Address - Country:US
Practice Address - Phone:561-412-8992
Practice Address - Fax:401-238-6057
Is Sole Proprietor?:No
Enumeration Date:2015-10-30
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP9358144163WG0600X, 363LG0600X, 363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology