Provider Demographics
NPI:1639880800
Name:COWAN, GRACE ELIZABETH (APRN, AANP-BC)
Entity Type:Individual
Prefix:MS
First Name:GRACE
Middle Name:ELIZABETH
Last Name:COWAN
Suffix:
Gender:F
Credentials:APRN, AANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 HENDRICKS ISLE
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33301-3702
Mailing Address - Country:US
Mailing Address - Phone:614-246-1129
Mailing Address - Fax:
Practice Address - Street 1:2631 E OAKLAND PARK BLVD STE 110
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33306-1607
Practice Address - Country:US
Practice Address - Phone:954-514-7306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-08
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11022619363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner