Provider Demographics
NPI:1639876782
Name:BOWMAN, STEPHANIE RAWLS (REGISTERED NURSE)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:RAWLS
Last Name:BOWMAN
Suffix:
Gender:F
Credentials:REGISTERED NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 RENNE DR N
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32218-4029
Mailing Address - Country:US
Mailing Address - Phone:904-521-8588
Mailing Address - Fax:904-358-4451
Practice Address - Street 1:1851 TALLEYRAND AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-5473
Practice Address - Country:US
Practice Address - Phone:904-358-4450
Practice Address - Fax:904-358-4451
Is Sole Proprietor?:No
Enumeration Date:2023-02-09
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9187422163WX0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WX0106XNursing Service ProvidersRegistered NurseOccupational Health