Provider Demographics
NPI:1861859076
Name:ROWE, LAKESHA M (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:LAKESHA
Middle Name:M
Last Name:ROWE
Suffix:
Gender:F
Credentials:MSN, APRN, 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:PO BOX 15459
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-5459
Mailing Address - Country:US
Mailing Address - Phone:850-215-3062
Mailing Address - Fax:850-215-3024
Practice Address - Street 1:2401 STATE AVE STE 100
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-3942
Practice Address - Country:US
Practice Address - Phone:850-215-3062
Practice Address - Fax:850-215-3024
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-19
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN9331644163W00000X
FLAPRN9331644363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019872000Medicaid
FL020424800Medicaid