Provider Demographics
NPI:1821694977
Name:MCCOWAN, MATTHEW LEE (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:LEE
Last Name:MCCOWAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5521 REDHAWK DR
Mailing Address - Street 2:
Mailing Address - City:NEW PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34655-1234
Mailing Address - Country:US
Mailing Address - Phone:727-666-3235
Mailing Address - Fax:
Practice Address - Street 1:5521 REDHAWK DR
Practice Address - Street 2:
Practice Address - City:NEW PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34655-1234
Practice Address - Country:US
Practice Address - Phone:727-666-3235
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-04
Last Update Date:2021-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAPRN11010188363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily