Provider Demographics
NPI:1710910849
Name:STOWELL, JOCELYN I (ARNP)
Entity Type:Individual
Prefix:
First Name:JOCELYN
Middle Name:I
Last Name:STOWELL
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 1:12832 NW CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:FL
Mailing Address - Zip Code:32321-6918
Mailing Address - Country:US
Mailing Address - Phone:850-643-2292
Mailing Address - Fax:850-643-2306
Practice Address - Street 1:12832 NW CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:FL
Practice Address - Zip Code:32321-0489
Practice Address - Country:US
Practice Address - Phone:850-643-2415
Practice Address - Fax:850-643-5689
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 1756862367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLY6921OtherBCBS
FL034569501Medicaid