Provider Demographics
NPI:1689886707
Name:COWAN, LINDA J (MSN, ARNP, CWS)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:J
Last Name:COWAN
Suffix:
Gender:F
Credentials:MSN, ARNP, CWS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27910 NW 46 AVENUE
Mailing Address - Street 2:
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669-2443
Mailing Address - Country:US
Mailing Address - Phone:352-472-4575
Mailing Address - Fax:
Practice Address - Street 1:1601 SW ARCHER RD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-1135
Practice Address - Country:US
Practice Address - Phone:352-376-1611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2009-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1363722363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL306906100Medicaid
FLY074MOtherBLUE CROSS
FLY074MOtherBLUE CROSS
FLQ46611Medicare UPIN