Provider Demographics
NPI:1851029235
Name:BOWDEN, QUANITA LATRICE
Entity Type:Individual
Prefix:
First Name:QUANITA
Middle Name:LATRICE
Last Name:BOWDEN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:480 N RANGE RD
Mailing Address - Street 2:
Mailing Address - City:COCOA
Mailing Address - State:FL
Mailing Address - Zip Code:32926-5355
Mailing Address - Country:US
Mailing Address - Phone:321-537-9022
Mailing Address - Fax:
Practice Address - Street 1:480 N RANGE RD
Practice Address - Street 2:
Practice Address - City:COCOA
Practice Address - State:FL
Practice Address - Zip Code:32926-5355
Practice Address - Country:US
Practice Address - Phone:407-967-6870
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-12
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL238489172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker