Provider Demographics
NPI:1659314714
Name:BOWLUS, LESLEY SONDRA (ARNP)
Entity Type:Individual
Prefix:MRS
First Name:LESLEY
Middle Name:SONDRA
Last Name:BOWLUS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1690 DUNLAWTON AVE
Mailing Address - Street 2:STE 120
Mailing Address - City:PORT ORANGE
Mailing Address - State:FL
Mailing Address - Zip Code:32127-8980
Mailing Address - Country:US
Mailing Address - Phone:386-295-1941
Mailing Address - Fax:
Practice Address - Street 1:3512 S ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32118-7639
Practice Address - Country:US
Practice Address - Phone:386-767-9544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2016-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP710782363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAE652XMedicare PIN
FL1659314714Medicare PIN